Current Realities of Wilms Tumor Burden and Therapy in Ghana
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Date
2024
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Publisher
Journal of Pediatric Surgery
Abstract
Background: Between 2005 and 2014, Ghana's Wilms tumor (WT) 2-year disease-free survival of 44%
trailed behind that of high-income countries. This study aimed to uncover social determinants of health
leading to preventable WT death in Ghana.
Methods: WT patient records (2014e2022) at Korle-Bu Teaching Hospital (KBTH; Ghana) were reviewed
retrospectively. Demographics, clinical course, tumor characteristics, and survival were evaluated using
t-tests, Pearson Chi-square, and multivariate Cox logistic regression.
Results: Of 127 patients identified, 65 were female. Median age was 44 months [IQR 25e66]. Forty-eight
patients (38%) presented with distant metastasis (75% lung, 25% liver), which associated with hypo albuminemia (p ¼ 0.009), caregiver informal employment (p ¼ 0.04), and larger tumors (p ¼ 0.002).
Despite neoadjuvant chemotherapy shrinking 84% of tumors, larger initial size associated with incom plete resection (p ¼ 0.046). Of 110 nephrectomies, 31 patients had residual disease, negatively impacting
survival (p ¼ 2.7 10 5
). Twenty-two patients (17%) abandoned treatment (45% before nephrectomy;
55% after nephrectomy), with seven patients ultimately lost to follow-up (LTFU). Decedents represented
43% of stage IV patients compared to 28% in other stages. Event-free survival (EFS) was 60% at 4 years
with overall survival (OS) at 67%.
Conclusions: Although Ghana's WT survival has improved, informal employment and distance from
KBTH predisposed patients to delayed referral, greater tumor burden, hypoalbuminemia, and lower
survival.
Type of Study: Prognosis Study.
Level of Evidence: II
Description
Research Article
Keywords
Wilms tumor, Social determinants of health, Survival
Citation
ontchou N-AT et al., Current Realities of Wilms Tumor Burden and Therapy in Ghana, Journal of Pediatric Surgery, https://doi.org/10.1016/j.jpedsurg.2024.03.032