Childhood Wilms' tumour: prognostic factors in North Central Nigeria.

Background: Childhood Wilms' tumour or nephroblastoma represents one of the challenges for paediatric oncologists in developing countries.
Objective: To review the clinical characteristics and outcome of management of childhood nephroblastoma in North- Central Nigeria.
Methods: The clinical, operative and histological records of children aged 15 years and below, that were managed for Wilms' tumour at the Jos University Teaching Hospital between 1998 and 2005 were retrospectively reviewed.
Results: There were 32 children (M:F=1.9:1) with histologically confirmed nephroblastoma seen over the 7-year period. Their median(range) age was 4 (3-15) years. The patients invariably presented with a palpable abdominal mass, but haematuria was exceptional. The neoplasm tended to be larger on average than those reported previously among Caucasian children. At presentation, 1 (3.1%) patient was in stage I, 8 (25%) stage II, 11 (34.4%) stage III and 12 (37.5%) stage IV. About 72% of the patients presented with stage III-IV disease. Poorly differentiated neoplasm was more common in male than in female patients. Nephrectomy and chemotherapy were the modality of treatment. Fifteen (46.9%) of the patients received little or no induction chemotherapy due to unavailability of drugs while only 12 (37.5%) received the prescribed maintenance treatment with the remainder getting erratic or no treatment. Overall, only 43.8% were alive between 1 and 9 months (median: 6 months) of follow-up period, but there was no survivor at two years after treatment.
Conclusion: Childhood nephroblastoma has a high mortality rate in north central Nigeria because of late clinical presentation with advanced disease, poor availability of cytotoxic drugs and frequent interruptions in treatment and inadequate follow-up.