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Surgical practices and oncological outcomes of Wilms tumor in a resource limited setting: a risk-adapted approach
Gaurav Ravi Kumar1, Anand Chetan Shah2, Anand Murali1
1Department of Surgical Oncology, Cancer Institute (W.I.A), 38, Sardar Patel Road, Chennai, 600036, Tamil Nadu, India.
Insights
Pediatric Wilms tumor survival in LMICs can match high-income countries using risk-adapted strategies and international protocols. This study shows comparable outcomes with upfront surgery versus neoadjuvant chemotherapy, emphasizing multidisciplinary care for improved pediatric cancer survival.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Global Health
Background:
- Wilms tumor (WT) is a common pediatric renal neoplasm globally.
- Survival rates for WT are suboptimal in low- and middle-income countries (LMICs) due to late presentation and limited healthcare access.
- This study addresses the challenge of improving WT outcomes in LMICs.
Purpose of the Study:
- To retrospectively analyze outcomes of pediatric Wilms tumor patients undergoing definitive surgery in an LMIC.
- To compare outcomes between upfront surgery (Group I) and neoadjuvant chemotherapy followed by surgery (Group II).
- To evaluate the feasibility of achieving high-income country survival rates in LMICs.
Main Methods:
- Retrospective analysis of 36 WT patients treated between 2011 and 2023 at a single LMIC institution.
- Patients were classified into upfront surgery (COG guidelines) and neoadjuvant chemotherapy followed by surgery (SIOP guidelines) groups.
- Surgical outcomes, post-operative morbidity, overall survival (OS), and event-free survival (EFS) were analyzed.
Main Results:
- No significant post-operative complications in Group I (upfront surgery) versus 15.3% in Group II (neoadjuvant chemotherapy).
- Lymph node involvement was 10% in Group I and 3.8% in Group II.
- Five-year OS was 90.9% (Group I: 83%, Group II: 92%) and EFS was 91.4% (Group I: 80%, Group II: 96%).
Conclusions:
- Risk-adapted strategies and multidisciplinary decision-making are crucial for improving WT outcomes in LMICs.
- Adherence to international protocols can lead to survival rates comparable to high-income countries.
- The findings support the implementation of evidence-based protocols in LMICs for pediatric renal neoplasms.
Purpose:
Wilms tumor (WT) is the most common renal neoplasm in children and the third most common pediatric cancer globally. Though survival rates exceed 90% in high-income countries, it is suboptimal in low- and middle-income countries (LMICs) due to late presentation, advanced disease stages, and limited healthcare access. We retrospectively analyzed WT patients undergoing definitive surgery between 2011 and 2023 from a single LMIC institution.
Methods:
Patients were classified into Group I (upfront surgery as per COG guidelines) and Group II (neoadjuvant chemotherapy followed by surgery as per SIOP guidelines). Surgical outcomes, post-operative morbidity, and oncological outcomes, including overall survival (OS) and event-free survival (EFS), were analyzed. Thirty-six patients were included: ten in Group I and twenty-six in Group II.
Results:
Significant post-operative complications occurred in 15.3% of Group II, while none were noted in Group I. Lymph node involvement rates were 10 and 3.8% in Groups I and II, respectively. The 5-year OS and EFS for the cohort were 90.9% (Group I 83%, Group II 92%) and 91.4% (Group I 80%, Group II 96%).
Conclusion:
Risk-adapted strategy, multi-disciplinary decision-making, adherence to international protocols can emulate survival outcomes comparable to high-income countries, even in LMICs.
