Abstract A094: Current realities of Wilms tumor burden and therapy in Ghana
Authors: Kontchou Nelly-Ange T. , Amankwah Emmanuel , Seidu Issah , Stafman Laura , Abrahams Afua O. , Appeadu-Mensah William , Lovvorn Harold N. , Renner Lorna A. 
Published: December 2023

Abstract
Background Wilms tumor (WT) disease-free survival at 2 years approached only 44% between 2005-2014 in Ghana, slightly improving to 50% in the next 4 years (versus 90% in high-resource countries). This study aimed to uncover socioeconomic and clinical factors that lead to preventable WT death in Ghana. Objective We endeavored to describe changes in WT outcome in Ghana in recent years by studying patients diagnosed with WT at Korle-Bu Teaching Hospital (KBTH; Accra) - the country's largest tertiary hospital. We analyzed socioeconomic factors, disease characteristics and treatment course to determine which social determinants of health impact treatment regimen, response, completion, and outcomes. Methods WT patient records (August 2014-June 2022) at KBTH were reviewed retrospectively. Demographics, social determinants of health, clinical course, and tumor characteristics were analyzed. Groups were compared using t-tests, Pearson Chi-square tests, and multivariate Cox logistic regression. Results: 127 WT patients (65 female) were identified (median age, 44 months [IQR 25-66]). Distance greater than 40 km from KBTH associated with delayed referral from outside hospitals (p=0.03). 48 patients (38%) presented with distant metastasis (75% lung, 25% liver), which associated with caregiver employment in the informal economy (p=0.003) and larger tumor size at presentation (p=0.002). Hypoalbuminemia also associated with larger tumor size (p=0.02) and metastasis (p=0.009). Although 84% of tumors regressed with neoadjuvant chemotherapy, larger initial size associated with incomplete R1/R2 resection (p=0.046). 110 patients had nephrectomy: 6 tumor rupture, 5 tumor spill, 11 lymphadenopathy, and 33 R1/R2 residual disease, which negatively impacted survival (p=2.7x10-5). Under-staging was likely since lymphadenectomy was only documented in 52% of cases. Hypoalbuminemia (p=0.005) and post-operative stage IV (p=1.2x10-5) also negatively impacted survival. 22 patients (17%) abandoned treatment (13 stage IV), with 6 eventually returning for care. 11 patients (50%) abandoned treatment before nephrectomy and were considered deceased. 11 patients (50%) abandoned treatment after nephrectomy, with 7 lost to follow-up (LTFU). Among patients presenting with metastases, 43% died, but 8% were LTFU. If no metastases, 28% died (4% LTFU). Multivariate analysis of distant metastasis at presentation, tumor size, distance from KBTH, employment status, histopathological risk status, and post-operative distant metastasis demonstrated a statistically significant association with survival (p=0.002). Excluding LTFU, 2- and 4-year overall survival were 67% and 56%, respectively. Including treatment abandonment, relapse, and death as negative events, 2- and 4-year event-free survival were 56% and 55%, respectively. Conclusion: Although WT survival in Ghana has improved, social factors impacting secure employment, distance from KBTH, and adherence to care predisposed patients to greater tumor burden, poorer nutritional status, R1/R2 resections, LTFU, and lower survival.
Citation Format: Nelly-Ange T. Kontchou, Emmanuel Amankwah, Issah Seidu, Laura Stafman, Afua O. Abrahams, William Appeadu-Mensah, Harold N. Lovvorn, Lorna A. Renner. Current realities of Wilms tumor burden and therapy in Ghana [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A094.