| ORIGINAL ARTICLE
|Year : 2022 | Volume
| Issue : 1 | Page : 42-52
A 10-year study of the outcome of wilms' tumor in central India and identifying practice gaps
Vikesh Agrawal1, Arpan Mishra2, Sanjay Kumar Yadav2, Dhananjaya Sharma2, Himanshu Acharya1, Aradhna Mishra3, Rekha Agrawal4, Roshan Chanchlani1
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
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.
Prof. Vikesh Agrawal
Department of Surgery, Pediatric Surgery Unit, Netaji Subhash Chandra Bose Government Medical College, Jabalpur - 482 003, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
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