Diabetes Mellitus and Metabolic Profile in Long-Term Survivors of Wilms Tumor: A Nationwide Cohort Study With Sibling Controls

BACKGROUND: As survival after Wilms tumor has markedly improved, focus on potential long-term consequences is necessary. We investigated the metabolic profile among Danish survivors of Wilms tumor >20 years from cancer diagnosis.

METHODS: As of January 15, 2015, we established a cohort of 20-plus-year survivors of Wilms tumor identified through the national cancer registries. Siblings contributed as controls. Participation included clinical examination with anthropometric measurements, blood samples, blood pressure measurements, and a comprehensive health questionnaire. Using logistic regression, we identified risk factors for diabetes mellitus (DM).

RESULTS: With a response rate of 64%, we included 99 survivors of Wilms tumor with a median of 37 years since diagnosis (median age of 41, range: 24-70), and 38 sibling controls (median age of 41, range: 24-66). An increased prevalence of DM was found in the survivors as compared with their siblings (15% vs. 0%). A logistic regression analysis adjusted for age at follow-up showed that left-sided versus right-sided abdominal radiation therapy was a risk factor for the development of DM (odds ratio [OR] 7.9, 95% confidence interval [CI]: 1.4-44). A larger fraction of the survivors was in active treatment for hypertension compared to siblings (42% vs. 37%), but with no significant difference in body mass index, hip, or waist circumferences. Furthermore, Wilms tumor survivors were more likely to be in active treatment with lipid-lowering agents (8% vs. 3%).

CONCLUSION: Left-sided abdominal radiation is a major risk factor for DM in long-term survivors of Wilms tumor. Patients may benefit from surveillance with increased focus on metabolic risk profile to decrease the risk of DM and cardiovascular events.