Howard Scott C, Metzger Monika L, Wilimas Judith A, Quintana Yuri, Pui Ching-Hon, Robison Leslie L, Ribeiro Raul C
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA.
Cancer. 2008 Feb 1;112(3):461-72. doi: 10.1002/cncr.23205.
Global studies of childhood cancer provide clues to cancer etiology, facilitate prevention and early diagnosis, identify biologic differences, improve survival rates in low-income countries (LIC) by facilitating quality improvement initiatives, and improve outcomes in high-income countries (HIC) through studies of tumor biology and collaborative clinical trials. Incidence rates of cancer differ between various ethnic groups within a single country and between various countries with similar ethnic compositions. Such differences may be the result of genetic predisposition, early or delayed exposure to infectious diseases, and other environmental factors. The reported incidence of childhood leukemia is lower in LIC than in more prosperous countries. Registration of childhood leukemia requires recognition of symptoms, rapid access to primary and tertiary medical care (a pediatric cancer unit), a correct diagnosis, and a data management infrastructure. In LIC, where these services are lacking, some children with leukemia may die before diagnosis and registration. In this environment, epidemiologic studies would seem to be an unaffordable luxury, but in reality represent a key element for progress. Hospital-based registries are both feasible and essential in LIC, and can be developed using available training programs for data managers and the free online Pediatric Oncology Networked Data Base (www.POND4kids.org), which allows collection, analysis, and sharing of data.
全球儿童癌症研究为癌症病因提供线索，促进预防和早期诊断，识别生物学差异，通过推动质量改进举措提高低收入国家（LIC）的生存率，并通过肿瘤生物学研究和协作性临床试验改善高收入国家（HIC）的治疗结果。在一个国家内的不同种族群体之间以及在种族构成相似的不同国家之间，癌症发病率存在差异。这种差异可能是遗传易感性、过早或延迟接触传染病以及其他环境因素造成的。据报告，低收入国家儿童白血病的发病率低于较富裕国家。儿童白血病的登记需要识别症状、迅速获得初级和三级医疗服务（儿科癌症科室）、正确诊断以及数据管理基础设施。在缺乏这些服务的低收入国家，一些白血病患儿可能在诊断和登记之前就已死亡。在这种环境下，流行病学研究似乎是一种负担不起的奢侈行为，但实际上却是取得进展的关键要素。在低收入国家，基于医院的登记系统既可行又至关重要，可以利用现有的数据管理人员培训项目和免费的在线儿科肿瘤联网数据库（www.POND4kids.org）来建立，该数据库允许数据的收集、分析和共享。
