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Related Experiment Videos

Ruptured Wilms Tumor: Clinical Features, Diagnostic Challenges, and Survival Outcomes.

Hiba Emadeldeen1, Khalil Ghandour2, Tamador Al-Shamaileh2

  • 1Department of Pediatrics, King Hussein Cancer Center, Amman 11941, Jordan.

Current Oncology (Toronto, Ont.)
|May 26, 2026
PubMed
Summary

Wilms tumor (WT) rupture significantly worsens outcomes, leading to advanced disease and poorer survival. Early detection and a multidisciplinary approach are crucial for managing ruptured Wilms tumor.

Keywords:
Middle EastSIOPWilms tumormasking effectnephroblastomasurvivaltumor rupture

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Area of Science:

  • Pediatric Oncology
  • Surgical Oncology
  • Clinical Research

Background:

  • Wilms tumor (WT) rupture is a severe complication associated with disease upstaging and intensified treatment requirements.
  • Understanding the clinical profile and outcomes of ruptured WT is critical for optimizing patient management.

Purpose of the Study:

  • To evaluate the clinical characteristics, radiological-pathological concordance, and survival outcomes of ruptured versus non-ruptured Wilms tumor.
  • To identify prognostic factors influencing survival in pediatric patients with Wilms tumor.

Main Methods:

  • A retrospective cohort study included 111 pediatric patients with unilateral WT treated between October 2014 and December 2023.
  • Tumor rupture was defined by preoperative CT, intraoperative findings, or pathological confirmation.
  • Survival outcomes (event-free survival and overall survival) were analyzed using Kaplan-Meier and Cox regression models.

Main Results:

  • Tumor rupture occurred in 15.3% of patients, associated with older age, larger tumor size, and lower hemoglobin levels.
  • Ruptured WT cases presented at advanced stages (III/IV) with higher rates of distant metastases.
  • Five-year event-free survival (44.1% vs. 75.8%) and overall survival (58.2% vs. 81.4%) were significantly lower in the ruptured group.
  • Rupture independently predicted increased risk of death (HR 17.62) and relapse (HR 8.1).

Conclusions:

  • Wilms tumor rupture is linked to advanced disease at presentation and significantly inferior survival outcomes.
  • Neoadjuvant chemotherapy can mask findings, creating discordance between initial assessments and post-chemotherapy pathology.
  • A multidisciplinary strategy integrating imaging, surgical details, and histology is vital for accurate staging and treatment planning in SIOP-based protocols.