Disease stage predicts survival in Wilms tumour in developing countries

Disease stage is the most important prognostic factor of Wilms tumour (WT) in developing countries, a recent study has found.

Researchers retrospectively analysed 84 WT patients (mean age, 38.87±28.66 months; 52.4 percent female) receiving care at a military hospital in Pakistan. Treatments were given according to the guidelines of the International Society of Paediatric Oncology.

There were four treatment-related mortalities, yielding an incidence rate of 4.8 percent. These included two cases of sinusoidal obstruction syndrome, one of Fanconi anaemia with metastatic disease, and one death during surgery. Seventeen patients relapsed, only three of whom were successfully rescued; the remaining 14 died of progressive disease.

The resulting overall survival (OS) rate was 78.6 percent (n=66), while the event-free survival (EFS) rate was 75 percent (n=63).

Multivariate logistic regression analysis showed that advanced disease stage was the strongest predictor of both OS (p=0.003) and EFS (p=0.021). For instance, OS was only 50.0 percent in patients with stage V disease, as opposed to 47.1 percent, 69.2 percent, 92.0 percent and 92.6 percent in those with stage IV, III, II, and I WT.

EFS, in comparison, was lowest in patients with stage IV WT (43.8 percent), followed by stage V (50.0 percent), stage III (69.2 percent), stage II (79.2 percent), and stage I (92.6 percent).

Metastatic disease likewise worsened outcomes. Both OS and EFS were 0 percent in patients who developed both pulmonary and hepatic metastases.