Bilateral Wilms' tumour: An international comparison of treatments and outcomes

Introduction: Wilms' tumour is the most common childhood renal malignancy, with 5-10% of cases presenting bilaterally 1 . However, there is currently no consensus between centres on optimal management of bilateral Wilms' tumours. This is an international multi-centre case series comparing management and outcomes of bilateral Wilms' tumours between low-income centres (LIC) and high-income centres (HIC). Methods: Patients with bilateral Wilms' tumour were identified from four tertiary referral centres internationally. Data were collected on baseline characteristics, disease status, treatment used and clinical outcomes. Results were compared between individual centres as well as between groups of low-income centres (LIC) and high-income centres (HIC). Results: Data were collected for forty patients. Most patients received preoperative chemotherapy (n = 38, 95%). The most common surgical procedures were bilateral nephron-sparing surgery (n = 10, 25%) and nephrectomy with partial nephrectomy (n = 20, 50%). Ten-year survival after treatment was as follows: LIC's n = 13 (65%); HIC's n = 20 (100%) (p = 0.01). Discussion: Ten-year survival was significantly higher in HIC's. Our results show this may be caused by patient factors such as later presentation with more advanced disease in low-income centres. This comparative case series is the first to report on a large number of cases from multiple international centres, and to compare key outcomes. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study compares the management and outcomes of bilateral Wilms' tumours between low-income centres and high-income centres, revealing significantly higher ten-year survival in high-income centres. This difference may be due to patient factors such as late disease diagnosis in low-income centres.