Current realities of Wilms tumor burden and therapy in Ghana

Background Between 2005-2014, Ghana’s Wilms tumor (WT) 2-year disease-free survival of 44% trailed behind 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=2.7x10-5). 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. Level of Evidence II