Investigation of pathways of prognostic importance in Wilms tumors

Wilms tumor is the most common renal malignancy in childhood. Although the prognosis is good and the overall survival is over 90%, some patients have poor prognostic factors such as local recurrence, distant metastasis, capsule and renal sinus invasion. Detailed clinical, histopathological, immunohistochemical and molecular investigations of prognostic factors are required for better prognosis prediction and treatment planning. Our aim in this study is to show whether there is a relationship between immunohistochemical P53, P21 positivity and Ki67 proliferation index along with demographic, clinical and histopathological features of a Wilms tumor case diagnosed in our center and to provide data on this subject from Turkey to the literature. In our study, 47 Wilms tumors were re-evaluated demographically, clinically and histopathologically. In addition, P53, P21 and Ki67 were applied immunohistochemically to two paraffin blocks selected from each case. Tumor size, stage of diagnosis, tumor localization, renal sinus invasion, post-treatment risk stratification, capsule invasion and immunohistochemical P53, P21 and Ki67 are our main variables and the relationships between them were evaluated. According to the results we obtained in our study, P53 positivity was found to be higher in tumors located in the right kidney. Stage 3-4-5 tumors were found to invade more capsules than Stage 1-2 tumors. 50% of those with capsule invasion and 16.2% of those without capsular invasion were found to be at stage 3 and above. This difference between the groups was statistically significant (p=0.039). It was noted that the percentage of KI67 staining in the group with capsular invasion was statistically significantly higher than the group without capsular invasion 73 (p=0.047). With these results, no statistically significant relationship was found in our study in terms of P53, P21 positivity and Ki67 proliferation index, except for capsule invasion, tumor localization and stage relationships. As a result, when the data we obtained and the literature data are evaluated together, it can be predicted that the immunohistochemical P53 and Ki67 markers may be helpful to examine. Still, especially the P21 marker may need to be more valuable for practical use. On the other hand, the low number of cases with anaplasia in our study may also have affected our results. In order to accurately determine the prognosis of WT, it is necessary to conduct large-scale studies that involve multiple centers, more cases, meta-analysis and the incorporation of molecular tests. Key words: Wilms tumor, P53, P21, Ki67, prognosis