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Localized Wilms' tumor in low-middle-income countries (LMIC): how can we get better?
Hosam Y Asfour1, Sahar A Khalil2, Al-Shimaa Zakaria3
1Pediatric oncology department, National Cancer Institute, Cairo University, and 57357 CCHE Hospital, Fom El-khalig Square, Kasr El-Aini St, Cairo, 11796, Egypt. hosam.asfour@gmail.com.
Insights
Pediatric loco-regional Wilms' tumor outcomes in Egypt approach developed country survival rates. However, event-free survival (EFS) is lower, particularly for stages I and II, with stage and histology significantly impacting survival.
Area of Science:
- Pediatric Oncology
- Cancer Research
- Clinical Outcomes
Background:
- Wilms' tumor (WT) is a significant childhood cancer, accounting for approximately 6% of cases.
- While survival rates exceed 90% in developed nations, disparities persist in developing countries.
- This study focuses on pediatric loco-regional WT cases treated at the National Cancer Institute (NCI), Cairo University, Egypt.
Purpose of the Study:
- To evaluate the clinical outcomes of pediatric loco-regional Wilms' tumor patients treated at NCI, Cairo University.
- To identify prognostic factors influencing patient outcomes in this cohort.
- To compare outcomes with those reported in developed countries.
Main Methods:
- A retrospective study design was employed.
- Included pediatric patients diagnosed with loco-regional Wilms' tumor between January 2008 and December 2017.
- Follow-up extended until June 2019.
Main Results:
- Ninety-two patients were analyzed, with a median age of 3 years.
- The 5-year overall survival (OS) and event-free survival (EFS) for the entire group were 94.6% and 83.7%, respectively.
- Stage III patients showed significantly lower OS (89.1%) compared to stages I and II (100%, p=0.024). Patients with unfavorable histology had significantly lower EFS and OS (50% and 83.3%) than those with favorable histology (88.8% and 96.3%, p<0.001 and p=0.043, respectively).
Conclusions:
- Pediatric loco-regional Wilms' tumor patients in Egypt achieved OS comparable to developed countries.
- Event-free survival (EFS) was lower than expected, particularly for stages I and II.
- Tumor stage and histological type are critical prognostic factors for survival in pediatric Wilms' tumor.
Background:
Wilms' tumor (WT) represents about 6% of all childhood cancers. The overall survival markedly improved to exceed 90% in developed countries, yet some studies from developing counties still have poorer outcomes. The aim of this study is to assess the clinical outcome and the different prognostic factors that influence the outcome of pediatric loco-regional WT cases treated at National Cancer Institute (NCI), Cairo University, Egypt. This is a retrospective study which included pediatric loco-regional WT patients presented between January 2008 and December 2017. Patients were followed up till June 2019.
Results:
Ninety-two eligible patients were included. Median age was 3 years (range 1 month-9 years). Abdominal mass was the commonest presentation (72.8%). The 5-year EFS and OS of the whole group was 83.7% and 94.6% retrospectively. Despite having a similar EFS (84.8 vs. 82.6%), stage III patients had a significantly lower OS than those in stages I and II (89.1% vs. 100%, p value 0.024). Twelve patients had unfavorable histology and had a significantly lower EFS and OS than the patients with favorable histology (50 and 83.3% vs. 88.8 and 96.3%, p value < 0.001 and 0.043, respectively).
Conclusion:
Loco-regional Wilms' tumor cases treated in Egypt had OS nearly the same as in developed countries, but had a lower EFS than expected mainly stages I and II. The stage and histological type are the main factors influencing the survival, and further studies are needed to investigate nuclear unrest grades and proper management of such cases.
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