{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:56:53Z","timestamp":1775897813492,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The objectives of this study were to evaluate the prognostic impact of pre\u2010referral surgical resection of Wilms tumor (WT) performed at non\u2010oncology centers, and to strategize an improved care plan for this very curable pediatric tumor.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this study conducted in a large pediatric cancer center in Pakistan, we retrospectively reviewed the electronic medical records (EMR) of 149 patients with unilateral WT from September 2008 to August 2017. Based on treatment approach, patients were categorized into two groups: (i) pre\u2010referral tumor resection (PTR: <jats:italic>n<\/jats:italic>\u00a0=\u00a075), and (ii) post\u2010neoadjuvant chemo nephrectomy (PCN: <jats:italic>n<\/jats:italic>\u00a0=\u00a074).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The proportion of metastatic disease in PTR and PCN groups was 33.3% and 35.1%, respectively. In the PTR subset, median time to admission after PTR was 5\u00a0weeks (mean 11, SEM 2.8, range: 2\u2013202) weeks, with 53.3% (<jats:italic>n<\/jats:italic>\u00a0=\u00a040) presenting more than 4\u00a0weeks after PTR. Twenty patients had no cross\u2010sectional imaging prior to PTR and underwent surgery after abdominal ultrasound only. On baseline imaging at our center, 58.7% (<jats:italic>n<\/jats:italic>\u00a0=\u00a044) of the PTR group had radiologically evaluable disease (four metastases only, 19 local residual tumor only, 21 both localized tumor and visible metastases). Disease staging was uncertain in 23 patients because of no or inadequate histology specimens and\/or lymph node sampling in patients with no evaluable disease. Statistically significant differences were recorded for the two subsets regarding tumor volume, extent and nodularity, renal vein and renal sinus involvement, lymph node status, tumor rupture and histopathologic features, and tumor stage, with a 10\u2010year event\u2010free survival (EFS) for PCN and PTR of 74.3% and 50.7%, respectively (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.001). In the PTR group, EFS for those presenting within 4\u00a0weeks and later was 91.4% versus 15.0%, respectively (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Suboptimal pre\u2010referral surgical intervention results in poor survival outcomes in unilateral WT. Our findings highlight the need for a comprehensive action plan for educating healthcare professionals engaged in WT diagnosis and referral process. PCN in a multidisciplinary team approach can reduce surgical morbidity and seems to be a better strategy to improve the survival rates in low\u2010resource settings.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.30760","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T13:15:05Z","timestamp":1699967705000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic impact of pre\u2010referral tumor resection in unilateral Wilms tumor: A single\u2010institute experience from a lower middle\u2010income country"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4213-275X","authenticated-orcid":false,"given":"Muhammad Saghir","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Pediatrics King Faisal Specialist Hospital and Research Center  Al Madinah Al Munawarrah Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1399-5994","authenticated-orcid":false,"given":"Ata Ur Rehman","family":"Maaz","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology Child Health, Sidra Medicine  Doha Qatar"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abid Quddus","family":"Qazi","sequence":"additional","affiliation":[{"name":"Pediatric Surgeon Al Jalila Children's Specialty Hospital Dubai  Dubai United Arab Emirates"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Aslam","sequence":"additional","affiliation":[{"name":"Pediatric Oncology Royal Victoria Infirmary  Newcastle upon Tyne UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shazia","family":"Riaz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology\/Oncology The Children's Hospital and Institute of Child Health Lahore  Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayesha Saeed","family":"Malik","sequence":"additional","affiliation":[{"name":"Department of Pediatrics King Edward Medical University  Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Najma","family":"Shaheen","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology Shaukat Khanum Cancer Hospital and Research Center  Lahore Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33147"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12030729"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41572\u2010021\u201000308\u20108"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.14694\/EdBook_AM.2014.34.215"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/GO.20.00170"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(18)30761\u20107"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.62.1888"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2017.163"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.5812\/ijp.366"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPH.0b013e3182580921"},{"key":"e_1_2_10_12_1","unstructured":"The World Bank.Countries and economies.World Bank. 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