Current Realities of Wilms Tumor Burden and Therapy in Ghana.

Autor: Kontchou NT; Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: nelly-ange.t.kontchou@vumc.org., Amankwah E; World Child Cancer, Accra, Ghana., Seidu I; University of Ghana Legon, Department of Statistics, Accra, Ghana., Stafman LL; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Zhao S; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA., Abrahams AOD; Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana., Appeadu-Mensah W; Department of Pediatric Surgery, Korle-Bu Teaching Hospital, Accra, Ghana., Lovvorn HN 3rd; Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA., Renner LA; Department of Pediatric Oncology, Korle-Bu Teaching Hospital, Accra, Ghana.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Jul; Vol. 59 (7), pp. 1342-1348. Date of Electronic Publication: 2024 Mar 16.
DOI: 10.1016/j.jpedsurg.2024.03.032
Abstrakt: 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 (2014-2022) 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 25-66]. Forty-eight patients (38%) presented with distant metastasis (75% lung, 25% liver), which associated with hypoalbuminemia (p = 0.009), caregiver informal employment (p = 0.04), and larger tumors (p = 0.002). Despite neoadjuvant chemotherapy shrinking 84% of tumors, larger initial size associated with incomplete resection (p = 0.046). Of 110 nephrectomies, 31 patients had residual disease, negatively impacting survival (p = 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.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: