Investigating Wilms’ Tumours Worldwide: A Report of the OxPLORE Collaboration—A Cross‐Sectional Observational Study

Abstract

Background Childhood cancer is neglected within global health. Oxford Pediatrics Linking Oncology Research with Electives describes early outcomes following collaboration between low-and high-income paediatric surgery and oncology centres. The aim of this paper is twofold: to describe the development of a medical student-led research collaboration; and to report on the experience of Wilms' tumour (WT). Methods This cross-sectional observational study is reported as per STROBE guidelines. Collaborating centres included three tertiary hospitals in Tanzania, Rwanda and the UK. Data were submitted by medical students following retrospective patient note review of 2 years using a standardised data collection tool. Primary outcome was survival (point of discharge/death). Results There were 104 patients with WT reported across all centres over the study period (Tanzania n = 71, Rwanda n = 26, UK n = 7). Survival was higher in the high-income institution [87% in Tanzania, 92% in Rwanda, 100% in the UK (X 2 36.19, p \ 0.0001)]. Given the short-term follow-up and retrospective study design, this likely underestimates the true discrepancy. Age at presentation was comparable at the two African sites but lower in the UK (one-way ANOVA, F = 0.2997, p = 0.74). Disease was more advanced in Tanzania at presentation (84% stage III-IV cf. 60% and 57% in Rwanda and UK, respectively, X 2 7.57, p = 0.02). All patients had pre-operative chemotherapy, and a majority had nephrectomy. Post-operative morbidity was higher in lower resourced settings (X 2 33.72, p \ 0.0001). Methodology involving medical students and junior doctors proved time-and cost-effective. This collaboration was a valuable learning experience for students about global research networks. Conclusions This study demonstrates novel research methodology involving medical students collaborating across the global south and global north. The comparison of outcomes advocates, on an institutional level, for development in access to services and multidisciplinary treatment of WT.

Advances in the clinical management of high‐risk Wilms tumors

“…[63][64][65] Malnutrition and poor clinical conditions due to advanced illness are common 66 and favor a higher incidence of severe treatment-related toxicities and deaths. 63,[67][68][69] The combination of poor clinical status at the time of diagnosis, shortage of essential medicines, high cost of treatment and transportation resulting in treatment abandonment or refusal, 67,[70][71][72] low treatment compliance, and utilization of inadequately intensive treatment including omission of RT negatively impact survival. 64,70 LMICs report a higher proportion of patients with anaplasia and advanced disease, which correlate with poor prognosis.…”

Lessons from developing, implementing and sustaining a participatory partnership for children’s surgical care in Tanzania

“…To date, the Tanzania partnership has generated 14 publications in peer-reviewed journals and 54 abstracts presented at international research meetings, 18 book chapters, 4 international fellowships in children’s surgery and 5 scholarships for training in better resourced parts of Africa 5 17–31. The Tanzanian research team are actively collaborating on the multi-site Global Paedsurg sub-Saharan African research21 and are one of four centres implementing the gastroschisis care bundle 20.…”

“…Now, local surgeons feel empowered and confident enough to perform cancer-related surgery in-country, with local follow-up care, and are no longer reliant on overseas teams to visit. A study done at MNH reported in-hospital survival of 87% for solid tumour surgery in children 23…”

ALKBH5 gene polymorphisms and Wilms tumor risk in Chinese children: A five‐center case‐control study

“…7,8 What is more frustrated, survivors may be subject to chronic severe health conditions. 9 Strong evidence has been increasingly added in supporting the contribution of genetic variants to Wilms tumor. The Wilms tumor 1 (WT1) gene, mapped to chromosome 11p13, was first identified in 1990 as a tumor suppressor gene in Wilms tumor.…”