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Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor: a systematic review and meta-analysis

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Abstract

To evaluate the efficiency and long-term renal function of nephron sparing surgery (NSS) in unilateral WT patients compared with radical nephrectomy (RN). The review was performed following Cochrane Handbook guidelines and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched five databases (Pubmed, Embase, Scopus, Web of Science and Cochrane) for studies reporting the efficiency and late renal function of NSS and/or RN on February 10, 2023. Comparative studies were evaluated by Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) and RoB 2.0. Assessed outcomes included survival rate, relapse rate, eGFR, renal dysfunction and hypertension. 26 studies involving 10322 unilateral WT cases underwent RN and 657 unilateral WT cases underwent NSS were enrolled. Overall effect estimates demonstrated that NSS significantly increased eGFR at follow-up (SMD, 0.38; 95% CI 0.05-0.72; p = 0.025) compared to that at diagnosis, and RN did not significantly decrease eGFR at follow-up (SMD, − 0.33; 95% CI − 0.77–0.11; p = 0.142) compared to that at diagnosis. Moreover, no significant difference was found in outcomes of survivability (OR, 1.38; 95% CI 0.82–2.32; p = 0.226), recurrence (OR, 0.62; 95% CI 0.34–1.12; p = 0.114), eGFR at follow-up (SMD, 0.16; 95% CI − 0.36–0.69; p = 0.538), renal dysfunction (OR, 0.36; 95% CI 0.07–1.73; p = 0.200) and hypertension (OR, 0.17; 95% CI 0.03–1.10; p = 0.063). Current evidence suggests that NSS is safe and effective for unilateral WT patients, because it causes better renal function and similar oncological outcomes compared with RN. Future efforts to conduct more high-quality studies and explore sources of heterogeneity is recommended.

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Data availability

All data generated or analyzed during this study are included in this published article.

Abbreviations

WT:

Wilms tumor

NSS:

Nephron-sparing surgery

RN:

Radical nephrectomy

PN:

Partial nephrectomy

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

ESRD:

End-stage renal disease

BP:

Blood pressure

RT:

Radiation therapy

PRISMA:

Preferred reporting items for systematic reviews and meta-analyses

SCr:

Serum creatinine

COG:

Children’s Oncology Group

SIOP:

International Society of Pediatric Oncology

NWTS:

National Wilms Tumor Study

RCT:

Randomized-controlled trial

OR:

Odds ratio

SMD:

Means and standard deviation

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Funding

This work is funded by Scientific Research Fund Project of Chongqing Municipal Health Commission (Construction and application of diagnostic and therapeutic model for pediatric solid tumors assisted by artificial intelligence, cstc2021ycjh-bgzxm0253).

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Authors and Affiliations

  1. Department of Urology, Children’s Hospital of Chongqing Medical University, Zhongshan 2nd Road, No.136, Yuzhong District, Chongqing, 400014, China

    Shan Li, **kui Wang, Mujie Li, Zhaoxia Zhang, Tao Mi, **n Wu, Zhang Wang, Liming ** & Dawei He

  2. Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, 400014, China

    Shan Li, **kui Wang, Mujie Li, Zhaoxia Zhang, Tao Mi, **n Wu, Zhang Wang, Liming ** & Dawei He

  3. China International Science and Technology Cooperation Base of Child Development and Critical Disorders, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children’s Hospital of Chongqing Medical University, Chongqing, 400014, China

    Shan Li, **kui Wang, Mujie Li, Zhaoxia Zhang, Tao Mi, **n Wu, Zhang Wang, Liming ** & Dawei He

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  1. Shan Li
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Contributions

SL: conceptualization, methodology, quality assessment, data collection, data analysis, and original draft writing. JW: conceptualization, quality assessment, and data collection. ML: conceptualization and manuscript revision. ZZ, ZW, XW, LJ, TM: data collection and manuscript revision. DH: supervision and manuscript editing.

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Correspondence to Dawei He.

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Li, S., Wang, J., Li, M. et al. Efficacy and late kidney effects of nephron-sparing surgery in the management of unilateral Wilms tumor: a systematic review and meta-analysis. Pediatr Surg Int 40, 29 (2024). https://doi.org/10.1007/s00383-023-05611-x

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