Kumar Gaurav Ravi, Shah Anand Chetan, Murali Anand, Krishnamurthy Shalini Shree, Radhakrishnan Venkatraman, Raja Anand
Department of Surgical Oncology, Cancer Institute (W.I.A), 38, Sardar Patel Road, Chennai, 600036, Tamil Nadu, India.
Surgical Oncology, Anand Onco Care, Surat, 395002, India.
Pediatr Surg Int. 2025 Apr 8;41(1):105. doi: 10.1007/s00383-025-05998-9.
Wilms tumor (WT) is the most common renal neoplasm in children and the third most common pediatric cancer globally. Though survival rates exceed 90% in high-income countries, it is suboptimal in low- and middle-income countries (LMICs) due to late presentation, advanced disease stages, and limited healthcare access. We retrospectively analyzed WT patients undergoing definitive surgery between 2011 and 2023 from a single LMIC institution.
Patients were classified into Group I (upfront surgery as per COG guidelines) and Group II (neoadjuvant chemotherapy followed by surgery as per SIOP guidelines). Surgical outcomes, post-operative morbidity, and oncological outcomes, including overall survival (OS) and event-free survival (EFS), were analyzed. Thirty-six patients were included: ten in Group I and twenty-six in Group II.
Significant post-operative complications occurred in 15.3% of Group II, while none were noted in Group I. Lymph node involvement rates were 10 and 3.8% in Groups I and II, respectively. The 5-year OS and EFS for the cohort were 90.9% (Group I 83%, Group II 92%) and 91.4% (Group I 80%, Group II 96%).
Risk-adapted strategy, multi-disciplinary decision-making, adherence to international protocols can emulate survival outcomes comparable to high-income countries, even in LMICs.
肾母细胞瘤（WT）是儿童最常见的肾脏肿瘤，也是全球第三大常见的儿科癌症。尽管在高收入国家生存率超过90%，但在低收入和中等收入国家（LMICs），由于就诊延迟、疾病分期较晚以及医疗服务可及性有限，生存率并不理想。我们回顾性分析了2011年至2023年间在一家单一的LMIC机构接受根治性手术的WT患者。
患者被分为I组（按照儿童肿瘤协作组[COG]指南进行 upfront手术）和II组（按照国际小儿肿瘤学会[SIOP]指南先进行新辅助化疗，然后进行手术）。分析了手术结果、术后发病率以及肿瘤学结果，包括总生存期（OS）和无事件生存期（EFS）。纳入了36例患者：I组10例，II组26例。
II组15.3%的患者出现了显著的术后并发症，而I组未观察到此类情况。I组和II组的淋巴结受累率分别为10%和3.8%。该队列的5年总生存期和无事件生存期分别为90.9%（I组83%，II组92%）和91.4%（I组80%，II组96%）。
即使在低收入和中等收入国家，风险适应性策略、多学科决策以及遵循国际方案也能够取得与高收入国家相当的生存结果。
