BACKGROUND: Nuclear unrest is a term applied to @entity3969 ( @entity3969 ) with favorable histology that show nuclear enlargement similar to that seen in anaplasia but with no abnormal mitotic figures. This study was undertaken to evaluate the clinical and pathogenetic significance of @entity3969 with nuclear unrest. METHODS: The authors reviewed primary nephrectomy specimens and clinical data from 173 @entity1 who were treated for @entity3969 on 1 of 5 consecutive clinical trials at St. Jude @entity1 's Research Hospital. A subset of 70 @entity1 was selected for @entity876 immunohistochemistry. Seventeen samples of recurrent @entity5 were also reviewed. RESULTS: @entity3969 with nuclear unrest had age and stage distribution similar to that for @entity3969 with favorable histology. @entity1 who had @entity5 with favorable histology, nuclear unrest, and anaplastic histology had 5-year cumulative incidences of recurrence of 12.2%, 22.2%, and 36.4%, respectively (P = 0.010). Despite the difference in recurrence incidence, @entity1 who had @entity5 with nuclear unrest and @entity1 who had @entity5 with favorable histology had nearly identical overall survival. Immunostaining for @entity876 was positive in 2 of 24 @entity5 (8.3%) with favorable histology, 1 of 25 @entity5 (4%) with nuclear unrest, and 16 of 21 @entity5 (76%) with anaplastic histology (P < 0.001). Histologic review of samples from recurrent @entity5 showed that 7 of 10 of @entity5 converted from favorable histology to either nuclear unrest or anaplastic histology in the recurrent @entity5 . CONCLUSIONS: @entity3969 with nuclear unrest more closely resembles favorable histology than anaplastic histology, both clinically and pathogenetically. Analysis of samples from recurrent @entity5 suggests that @entity3969 with nuclear unrest represents an intermediary in the continuum from favorable histology to anaplastic histology. For treatment stratification, it is appropriate to continue grouping nuclear unrest with favorable histology, although a larger analysis will be necessary to confirm the current findings.

Clinical and biologic significance of nuclear unrest in XXXX .

@entity3969 :: ('MESH:D009396', 'Disease') :: ['Wilms tumors', 'WT'] @entity1 :: ('9606', 'Species') :: ['Patients', 'patients', 'Children'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor', 'primary tumors', 'tumors'] @entity876 :: ('7157', 'Gene') :: ['p53']
@entity3969 :: (MESH:D009396,Disease) :: ['Wilms tumor']
