Association of Systemic Inflammatory Markers and Clinical Outcomes Among Children With Wilms Tumor

Background: Elevated pre-treatment inflammatory markers predict disease progression and overall survival among adults with renal tumors, including elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). We hypothesized that elevated inflammatory markers at diagnosis predict higher disease stages and adverse outcomes for children with Wilms tumor. Procedure: We performed a retrospective review of children with Wilms tumor who underwent surgical resection at two centers from 2002 to 2022. Differences in patient demographics and laboratory parameters were compared between the overall disease stages. Differences in tumor characteristics and patient outcomes were compared by elevated LMR, NLR, and PLR at diagnosis using Wilcoxon tests and chi-squared or Fisher's exact tests. For LMR, NLR, and PLR, optimal cut points for predicting disease ≥ stage 3 were determined using the Youden index for optimization. Results: Data were collected from 235 children with Wilms tumor. The median age was 39.8 months and 50.2% of patients were female; 40 had stage 1 disease, 50 had stage 2 disease, 61 had stage 3 disease, 54 had stage 4 disease, and 26 had stage 5 disease. Preoperative inflammatory markers varied with the overall stage. LMR, NLR, and PLR increased as the stage increased. After controlling for age, final histology, and any abnormal genetic marker, elevated NLR, PLR, and LMR at presentation were each associated with si