A 10-Year Study of the Outcome of Wilms' Tumor in Central India and Identifying Practice Gaps

Vikesh Agrawal; Arpan Mishra; Sanjay Kumar Yadav; Dhananjaya Sharma; Himanshu Acharya; Aradhna Mishra; Rekha Agrawal; Roshan Chanchlani

doi:10.4103/jiaps.JIAPS_314_20

A 10-Year Study of the Outcome of Wilms' Tumor in Central India and Identifying Practice Gaps

J Indian Assoc Pediatr Surg. 2022 Jan-Feb;27(1):42-52. doi: 10.4103/jiaps.JIAPS_314_20. Epub 2022 Jan 11.

Authors

Vikesh Agrawal¹, Arpan Mishra², Sanjay Kumar Yadav², Dhananjaya Sharma², Himanshu Acharya¹, Aradhna Mishra³, Rekha Agrawal⁴, Roshan Chanchlani¹

Affiliations

¹ Department of Surgery, Pediatric Surgery Unit, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India.
² Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India.
³ Department of Consultant Pediatric Oncologist, Omega Children Hospital, Jabalpur, Madhya Pradesh, India.
⁴ Department of Radiodiagnosis, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, Madhya Pradesh, India.

Abstract

Introduction: Despite remarkable improvement in Wilms' tumor (WT) survival in Western world, sub-optimal outcome in resource-constrained settings is influenced by late presentation, larger size, and poor access to treatment. This prompted us to study the outcome at a tertiary care center and to identify the global and local practice gaps.

Materials and methods: A retrospective, observational study of WT was conducted from October 2009 to September 2019 at a tertiary care setting. Following the National Wilms' Tumor Study Group protocol, an upfront nephrectomy (unilateral resectable tumors) and preoperative chemotherapy (large/unresectable Stage I-III) were followed. The records were reviewed for demographics, stage, preoperative chemotherapy, predictive factors, and outcome. Survival curves were plotted by the Kaplan-Meier method, and analysis was performed using the SPSS software version 16.

Results: One hundred and fifty-six children were included, median age was 4.1 years, with a male predominance. The most common stages of the presentation were II (40.4%) and III (34.6%). An upfront surgery was done in 27.6%, while remaining received preoperative chemotherapy. The median follow-up was 22 months, and the events included relapse in 46 (29.48%) and death in 54 (34.61%). The mean survival time was 45.7 (95% confidence interval [CI], 41.08-50.30). The 2-year overall survival was 65.38% (95% CI, 59-73), and the 2-year event-free survival was 36% (95% CI, 32-41). On comparison of the impact of preoperative chemotherapy, the survival estimates in Stages I-III and relapse rate were statistically similar, tumor size reduced significantly, and tumor spill was significantly lower (P < 0.05).

Conclusion: WT is associated with late presentation, sub-optimal survival, and higher relapse in our setting associated with practice gaps related to the management including practice violations.

Keywords: Outcome; Wilms' tumor; practice gaps; resource-constrained settings.