PREDICTORS OF SURVIVAL OUTCOMES OF WILMS TUMOR TREATED FOLLOWING THE SIOP 2001, LAHORE PAKISTAN EXPERIENCE

Background: Wilms tumor is the most common pediatric renal neoplasm. Various histological subtypes, risks, and clinical stages are determined after preoperative therapy. The survival outcomes of different subtypes are excellent depending upon the patient’s stage. In developed countries, overall survival and disease-free survival are remarkably high due to early presentation and close follow-up. Methodology A retrospective study was conducted at the Pediatric Hematology/Oncology Department, Children’s Hospital Lahore. All diagnosed WT cases from 1st January 2014 who completed their treatment before 31st December 2018 were included. Entire management was based on SIOP 2001. Patients presenting before nephrectomy received four preoperative chemotherapy cycles depending on the clinical stage. After nephrectomy, the postoperative chemotherapy regimen was based on the patient's stage, risk stratification, and metastatic status. The survival outcomes of different histopathological subtypes, and stages were determined via Kaplan-Meier survival analysis, and the p-value was calculated via a log-rank test. Results: The mean age of the 93 children was 44.4+ 30.92 months. The majority of the cases were males (55.9%) and commonly noted in the right-sided kidney (55.9%). Most patients completed the entire course of treatment (77.4%). The overall survival of the whole cohort was 88.2%, and event- free survival was 77.4%, at the 36-month follow-up. In our study, OS significantly dropped from 94.4% in stage II to 66.7% in stage IV disease (P< 0.001). Our study showed that there were more deaths of patients during the course of treatment by febrile neutropenia rather than relapse which affected treatment outcomes. Conclusions: Our study showed that advanced-stage presentations and febrile neutropenia during treatment contribute to the decreased OS and EFS seen in different histological subtypes and stages. Despite belonging to a low-middle-income class country and having an uneducated background, the majority of the patients completed the entire course of treatment, and relapse was fairly rare. The perks of the current study are that our hospital is the only pediatric tertiary care center in Lahore, which has investigated a variety of parameters influencing the course of WT treatment over three years.