Demanelis Kathryn, Sriplung Hutcha, Meza Rafael, Wiangnon Surapon, Rozek Laura S, Scheurer Michael E, Lupo Philip J
Department of Environmental Health Sciences, University of Michigan, Ann Arbor, Michigan.
Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand.
Pediatr Blood Cancer. 2015 Oct;62(10):1790-8. doi: 10.1002/pbc.25571. Epub 2015 May 11.
Childhood leukemia incidence and survival varies globally, and this variation may be attributed to environmental risk factors, genetics, and/or disparities in diagnosis and treatment.
We analyzed childhood leukemia incidence and survival trends in children aged 0-19 years from 1990 to 2011 in Songkhla, Thailand (n = 316) and compared these results to US data from the Surveillance, Epidemiology, and End Results (SEER) registry (n = 6,738). We computed relative survival using Ederer II and estimated survival functions using the Kaplan-Meier method. Changes in incidence and 5-year survival by year of diagnosis were evaluated using joinpoint regression and are reported as annual percent changes (APC).
The age-standardized incidence of leukemia was 3.2 and 4.1 cases per 100,000 in Songkhla and SEER-9, respectively. In Songkhla, incidence from 1990 to 2011 significantly increased for leukemia (APC = 1.7%, P = 0.031) and acute lymphoblastic leukemia (ALL) (APC = 1.8%, P = 0.033). Acute myeloid leukemia (AML) incidence significantly increased (APC = 4.2%, P = 0.044) and was significantly different from the US (P = 0.026), where incidence was stable during the same period (APC = 0.3%, P = 0.541). The overall 5-year relative survival for leukemia was lower than that reported in the US (43 vs. 79%). Five-year survival significantly improved by at least 2% per year from 1990 to 2011 in Songkhla for leukemia, ALL, and AML (P < 0.050).
While leukemia and ALL incidence increased in Songkhla, differences in leukemia trends, particularly AML incidence, may suggest etiologic or diagnostic differences between Songkhla and the US. This work highlights the importance of evaluating childhood cancer trends in low- and middle-income countries.
儿童白血病的发病率和生存率在全球范围内存在差异，这种差异可能归因于环境风险因素、遗传学以及诊断和治疗方面的差异。
我们分析了1990年至2011年泰国宋卡府0至19岁儿童的白血病发病率和生存趋势（n = 316），并将这些结果与美国监测、流行病学和最终结果（SEER）登记处的数据（n = 6,738）进行比较。我们使用埃德勒二世法计算相对生存率，并使用卡普兰-迈耶方法估计生存函数。通过连接点回归评估按诊断年份划分的发病率和5年生存率的变化，并报告为年度百分比变化（APC）。
宋卡府和SEER-9地区白血病的年龄标准化发病率分别为每10万人3.2例和4.1例。在宋卡府，1990年至2011年白血病（APC = 1.7%，P = 0.031）和急性淋巴细胞白血病（ALL）（APC = 1.8%，P = 0.033）的发病率显著增加。急性髓细胞白血病（AML）发病率显著增加（APC = 4.2%，P = 0.044），且与美国有显著差异（P = 0.026），美国同期发病率稳定（APC = 0.3%，P = 0.541）。白血病的总体5年相对生存率低于美国报告的生存率（43%对79%）。1990年至2011年，宋卡府白血病、ALL和AML的5年生存率每年显著提高至少2%（P < 0.050）。
虽然宋卡府白血病和ALL的发病率有所增加，但白血病趋势的差异，特别是AML发病率的差异，可能表明宋卡府和美国在病因或诊断方面存在差异。这项工作凸显了评估低收入和中等收入国家儿童癌症趋势的重要性。
