Long-term outcomes and prognostic factors in pediatric Wilms tumor: a 47-year single-center experience

Wilms tumor is the most common renal malignancy in children. Survival rates now exceed 90% with multimodal therapy. This study aims to retrospectively analyze 104 pediatric Wilms tumor patients diagnosed over a 47-year period at our institution, examining demographic characteristics, tumor staging, treatment modalities, complications, recurrence rates, and survival outcomes.

This retrospective single-center study included 104 pediatric patients diagnosed with Wilms tumor between January 1, 1978, and January 31, 2025. Patients were stratified into early (1978-2005) and late (2006-2025) periods. Survival analysis was performed using the Kaplan-Meier method and multivariable Cox proportional hazards regression.

The 5-year overall survival (OS) and event-free survival rates were 61.1% and 57.3% in the early era, 86.8% and 81.5% in the late era, and 73.6% and 65.8% in the overall cohort. OS was significantly lower in patients with anaplasia (p=0.035), advanced-stage disease (p=0.004), and in those treated in the early era (p=0.009). In multivariable analysis, treatment era and metastatic disease at diagnosis were independently associated with poorer survival, whereas anaplasia did not retain statistical significance after adjustment.

Survival outcomes improved substantially over time. Metastatic disease at diagnosis and treatment era were the strongest independent predictors of survival, while advanced stage and anaplasia were associated with outcome in univariable analyses.