Between 2005 and 2014, Ghana's Wilms tumor (WT) 2-year disease-free survival of 44% trailed behind that of high-income countries. This study aimed to uncover social determinants of health leading to preventable WT death in Ghana. 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. 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 = 2.7 × 10). 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%. 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. Prognosis Study. II.

中文翻译：

---

加纳维尔姆斯肿瘤负担和治疗的现状

2005年至2014年间，加纳的肾母细胞瘤（WT）2年无病生存率为44%，落后于高收入国家。本研究旨在揭示导致加纳可预防的 WT 死亡的健康社会决定因素。对 Korle-Bu 教学医院（KBTH；加纳）的 WT 患者记录（2014-2022 年）进行了回顾性审查。使用 t 检验、Pearson 卡方和多元 Cox 逻辑回归评估人口统计学、临床病程、肿瘤特征和生存率。在已确定的 127 名患者中，有 65 名是女性。中位年龄为 44 个月 [IQR 25–66]。 48 名患者 (38%) 出现远处转移（75% 肺，25% 肝），这与低蛋白血症 (p = 0.009)、护理人员非正规就业 (p = 0.04) 和较大肿瘤 (p = 0.002) 相关。尽管新辅助化疗缩小了 84% 的肿瘤，但较大的初始尺寸与不完全切除相关 (p = 0.046)。在 110 例肾切除术中，31 例患者存在残留病灶，对生存产生负面影响 (p = 2.7 × 10)。 22 名患者 (17%) 放弃治疗（肾切除术前 45%；肾切除术后 55%），其中 7 名患者最终失访 (LTFU)。死者占 IV 期患者的 43%，而其他阶段的这一比例为 28%。 4 年无事件生存率 (EFS) 为 60%，总生存率 (OS) 为 67%。尽管加纳的 WT 生存率有所提高，但非正规就业和距 KBTH 的距离容易导致患者延迟转诊、更大的肿瘤负担、低蛋白血症和较低的生存率。预后研究。二.