Paediatric nephroblastoma at a South African tertiary hospital: A 21-year retrospective analysis

Nephroblastoma (Wilms tumour) is one of the most common solid tumours of all paediatric cancers (prevalence of 5% globally and 13.5% in South Africa (SA)), with suboptimal survival outcomes, impacting children's lives. Consequently, there is an urgent need for enhanced early detection strategies, addressing survival rate disparities and late-stage presentations to improve outcomes.

To assess profiles, disease presentations, management and outcomes of patients with nephroblastoma at Universitas Academic Hospital Complex (UAHC), and to compare patients from SA and Lesotho, including differences between early and late presenters and reasons for delayed presentation.

This retrospective cross-sectional study included 207 paediatric oncology patients treated for nephroblastoma at the Paediatric Haematology and Oncology Unit at UAHC, Bloemfontein, SA, from January 2000 to December 2020.

The median age of the study population was 38 months, with a marginal male predominance (50.7%). A 1-month delay occurred between symptom onset and diagnosis, commonly attributed to delayed care-seeking, impacting survival rates. Compared with similar SA studies, a higher stage IV disease rate (29.5%) was observed, and encouraging survival rates (59.4%) correlated with favourable preoperative histology and no relapse. In comparison, Lesotho patients experienced longer delays and presented with more severe disease.

This study highlights the need for collaboration between SA and Lesotho healthcare providers to improve outcomes by addressing diagnostic delays, treatment defaults and response variations in resource-limited settings through community health education, improving access to primary care, offering care-provider training, improving diagnostic resources and addressing socioeconomic barriers.