# Predictors of Clinical Outcome in Primary Progressive and Relapsed Wilms Tumor in a Resource-Limited Setting

## TL;DR

This study identifies poor survival predictors in children with Wilms tumor in a South Asian setting, emphasizing advanced disease stage and treatment response.

## Contribution

The study provides insights into prognostic factors for Wilms tumor in a resource-limited region, highlighting stage and remission status as key predictors.

## Key findings

- 58 out of 452 children (13%) developed relapse or disease progression.
- Five-year overall survival was 43%, with event-free survival dropping to 20% at two years.
- Stage 4 disease at diagnosis had a worse survival rate (24%) compared to stage 3 (49%).

## Abstract

Objective: This study aims to evaluate survival outcomes and identify prognostic factors associated with relapse or treatment-refractory primary progressive Wilms tumor in a resource-limited South Asian setting.

Study design and setting: This is a retrospective cohort study conducted at a single tertiary-care pediatric oncology center in Pakistan.

Materials and methods: Clinical charts of patients aged under 18 years were retrospectively examined and included. Patients who had been diagnosed with relapsed or treatment-refractory primary progressive Wilms tumor during the period between January 2010 and December 2023 were included in the study. The occurrence of disease following full remission after usual therapy was termed relapse, whereas the absence of radiologic or symptomatic response to the first chemotherapy was termed primary progressive disease. The Kaplan-Meier was used to estimate overall survival and event-free survival.

Results: Among 452 children treated for Wilms tumor, 58 (13%) developed relapse or disease progression. Five-year overall survival was 43% (95% confidence interval: 29-57%). Event-free survival (survival without relapse, progression, death, or abandonment) fell to 28% at one year and 20% at two years. At the time of diagnosis, stage 4 disease had a worse survival rate than stage 3 (24% vs 49%).

Conclusions: Presentation at an advanced stage of the disease and the inability to achieve first remission are strong predictors of poor survival.