Childhood cancers

Cancer stats improved with Toronto staging guidelines


Staging of childhood cancers hasn’t been well documented in the past but a new study has provided the first snapshot of stage at diagnosis and stage-specific survival across the nation.

According to the study published in Cancer Epidemiology, the Australia Childhood Cancer Registry is the first in the world to implement the Toronto Paediatric Cancer Stage Guidelines.

The study comprising 1,760 cases across 12 solid cancers found about 71% of the paediatric patients had local or regionalised disease while 29% had metastatic disease.

“This distribution varied widely by the type of cancer; less than half (43%) of children with neuroblastoma had localised or regional disease at diagnosis, compared to 95% with ovarian germ cell tumours and 99% with retinoblastoma,” the study said.

Overall 20% of the children died either during the study period 2006-2014 or through to the end of 2015.

“Children with medulloblastoma (n=99, 38%), ependymoma (n=30, 29%) and osteosarcoma (n=22, 28%) had the highest proportions of deaths due to any cause, while in contrast all children in the study cohort with testicular germ cell tumours and nearly all with either retinoblastoma or ovarian germ cell tumours remained alive by the end of the study period.”

The study found that, where there were sufficient cases for the analysis, there was a significant impact of cancer stage on survival.

“The largest differences in five-year observed survival by stage at diagnosis were observed for osteosarcoma (85% for localised cases versus 37% for children with metastatic disease), neuroblastoma (98% for stage L1 versus 60% for metastatic (excluding stage MS)), rhabdomyosarcoma (85% for stage I versus 53% for stage IV), non-rhabdomyosarcoma soft tissue sarcoma (89% for stages I and II combined versus 47% for stage IV) and medulloblastoma (69% for stage M0 versus 42% for stage M3).”

While such findings may be expected, they contrast with similar staging work done in childhood haematological cancers recently by the same team, and previously reported in the limbic. That study found the overall difference in leukaemia and lymphoma survival by stage at diagnosis was not statistically significant.

The researchers said their findings represent ‘an important step towards consistent and reliable information on stage for childhood cancers within Australia’.

“Further, they demonstrate that it is feasible to achieve robust, national population-based information stratified by stage. Such data, if available internationally, have the potential to contribute to improved epidemiological reporting for childhood cancers globally, help to shed light on the factors underlying the marked international inequity in outcomes, and inform interventions to reduce these disparities.”

The study was funded by Cancer Australia.

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