Valsecchi M G, Tognoni G, Bonilla M, Moreno N, Baez F, Pacheco C, Hernandez A P, Antillon-Klussmann F, Machin S, Cabanas R, Navarrete M, Nieves R, De Lorenzo P, Masera G
Department of Clinical Medicine, Prevention and Biotechnologies, Section of Medical Statistics, University of Milano-Bicocca, Monza, Italy.
Ann Oncol. 2004 Apr;15(4):680-5. doi: 10.1093/annonc/mdh148.
Countries with scarce resources have the right to appropriate essential health care but very few reports discuss how this can be achieved. We assessed the survival of a large cohort of pediatric oncological patients to provide hard data on which to base realistic evaluation and planning schemes.
This multicenter retrospective survey covered consecutively diagnosed and treated patients admitted to eight national level hospitals in seven countries in Central America and the Caribbean. The research protocol was discussed extensively, so the data to be collected and the criteria for their evaluation were clearly pre-defined. We analysed 2214 patients diagnosed between 1996 and 1999 with various cancers, classified as hemato-oncological disorders (70%) and solid tumors (30%).
Three-year overall survival was 48.4% [standard error (SE) 1.3]. Detailed analysis of acute lymphoblastic leukemia highlighted the wide intercountry variability: 3-year survival was 62.2% (SE 5.3) in Cuba, 74.2% (SE 3.3) in Costa Rica, 61.7% (SE 4.9) in Nicaragua, and lower in the other four countries.
The yield of diagnostic-therapeutic protocols depends largely on the context of care in which they are applied. This paper documents the importance of including epidemiological research in interventions for cooperation in complex health areas such as pediatric oncology.
资源匮乏的国家有权获得适当的基本医疗保健，但很少有报告讨论如何实现这一点。我们评估了一大群儿科肿瘤患者的生存率，以提供可靠数据，作为现实评估和规划方案的依据。
这项多中心回顾性调查涵盖了中美洲和加勒比地区七个国家八家国家级医院连续诊断和治疗的患者。对研究方案进行了广泛讨论，因此明确预先定义了要收集的数据及其评估标准。我们分析了1996年至1999年间诊断出患有各种癌症的2214名患者，这些癌症分为血液肿瘤疾病（70%）和实体瘤（30%）。
三年总生存率为48.4%[标准误（SE）1.3]。对急性淋巴细胞白血病的详细分析突出了各国之间的巨大差异：古巴的三年生存率为62.2%（SE 5.3），哥斯达黎加为74.2%（SE 3.3），尼加拉瓜为61.7%（SE 4.9），其他四个国家较低。
诊断治疗方案的效果很大程度上取决于其应用的护理环境。本文记录了在儿科肿瘤学等复杂健康领域的合作干预措施中纳入流行病学研究的重要性。
