Cancer Council Queensland, Brisbane, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
Cancer Council Queensland, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
Lancet Child Adolesc Health. 2018 Mar;2(3):173-179. doi: 10.1016/S2352-4642(18)30023-3. Epub 2018 Feb 1.
Cancer stage at diagnosis is crucial for assessing global efforts to increase awareness of childhood cancer and improve outcomes. However, consistent information on childhood cancer stage is absent from population cancer registries worldwide. The Toronto Childhood Cancer Stage Guidelines, compiled through an international consensus process, were designed to provide a standard framework for collection of information on stage at diagnosis of childhood cancers. We aimed to assess the feasibility of implementing the Toronto Guidelines within a national population cancer registry.
We did a population-based registry study using data from the Australian Childhood Cancer Registry and included data from children aged 0-14 years diagnosed between Jan 1, 2006, and Dec 31, 2010 with one of 16 childhood cancers listed in the Toronto Guidelines (acute lymphoblastic leukaemia, acute myeloid leukaemia, Hodgkin's lymphoma, non-Hodgkin lymphoma, neuroblastoma, Wilms' tumour, rhabdomyosarcoma, non-rhabdomyosarcoma soft tissue sarcoma, osteosarcoma, Ewing's sarcoma, retinoblastoma, hepatoblastoma, testicular cancer, ovarian cancer, medulloblastoma, and ependymoma). We extracted data from medical records, and assigned stage according to the Tier 1 criteria (basic) and Tier 2 criteria (more detailed, requiring data from cytology, imaging, and other diagnostic tests, where available) using computer algorithms derived from the Toronto Guidelines. Additionally, expert reviewers independently assigned Tier 2 stage to a random subsample of 160 cases (ten per malignancy type). Feasibility of the guidelines was assessed on the percentage of cases that could be staged, agreement between stage assigned by the algorithms and the expert reviewers, and the mean time (min) taken to collect the required data.
We obtained data for 1412 eligible children. Stage could be assigned according to Tier 2 criteria for 1318 (93%) cases, ranging from 48 (84%) of 57 cases of non-rhabdomyosarcoma soft tissue sarcoma to 46 (100%) cases of hepatoblastoma. According to Tier 1 criteria, stage could be assigned for 1329 (94%) cases, ranging from 131 (87%) of 151 cases of acute myeloid leukaemia to 46 (100%) cases of hepatoblastoma. By contrast, stage at diagnosis was recorded by the treating physician for 555 (39%) of the 1412 cases. The computer algorithm assigned the same stage as did one or more independent expert reviewers in 155 (97%) of the 160 cases assessed. The mean time taken to review medical records and extract the required data was 18·0 min (SD 9·5 per case).
The Toronto Guidelines provide a highly functional framework that can be used to assign cancer stage at diagnosis using data routinely available in medical records for most childhood cancers. Data on staging have the potential to inform interventions targeting improved diagnosis and survival.
Cancer Australia.
癌症诊断时的分期对于评估全球提高儿童癌症认识和改善治疗效果的努力至关重要。然而，世界各地的人群癌症登记处都缺乏关于儿童癌症分期的一致信息。《多伦多儿童癌症分期指南》是通过国际共识过程编制的，旨在为儿童癌症诊断时分期信息的收集提供一个标准框架。我们旨在评估在国家人群癌症登记处实施《多伦多指南》的可行性。
我们使用澳大利亚儿童癌症登记处的数据进行了一项基于人群的登记研究，纳入了 2006 年 1 月 1 日至 2010 年 12 月 31 日期间诊断为 16 种儿童癌症（急性淋巴细胞白血病、急性髓细胞白血病、霍奇金淋巴瘤、非霍奇金淋巴瘤、神经母细胞瘤、肾母细胞瘤、横纹肌肉瘤、非横纹肌肉瘤软组织肉瘤、骨肉瘤、尤文肉瘤、视网膜母细胞瘤、肝母细胞瘤、睾丸癌、卵巢癌、髓母细胞瘤和室管膜瘤）且年龄在 0-14 岁的儿童的数据。我们从病历中提取数据，并根据Tier 1 标准（基本）和 Tier 2 标准（更详细，需要细胞学、影像学和其他诊断测试的数据，在有条件的情况下）使用源自《多伦多指南》的计算机算法进行分期。此外，专家评审员还对 160 例（每类恶性肿瘤 10 例）随机子样本的 Tier 2 分期进行了独立评估。我们评估了指南的可行性，包括分期的病例百分比、算法和专家评审员分配的分期之间的一致性以及收集所需数据所需的平均时间（分钟）。
我们获得了 1412 名合格儿童的数据。根据 Tier 2 标准，可以对 1318 例（93%）病例进行分期，范围从 57 例非横纹肌肉瘤软组织肉瘤中的 48 例（84%）到 46 例肝母细胞瘤中的 46 例（100%）。根据 Tier 1 标准，可以对 1329 例（94%）病例进行分期，范围从 151 例急性髓细胞白血病中的 131 例（87%）到 46 例肝母细胞瘤中的 46 例（100%）。相比之下，1412 例病例中有 555 例（39%）由治疗医生记录了诊断时的分期。在评估的 160 例病例中，有 155 例（97%）的计算机算法与一名或多名独立专家评审员分配的分期相同。审查病历和提取所需数据的平均时间为 18.0 分钟（每个病例的标准差为 9.5）。
《多伦多指南》提供了一个功能强大的框架，可用于使用病历中常规可用的数据为大多数儿童癌症分配诊断时的分期。分期数据有可能为针对提高诊断和生存率的干预措施提供信息。
澳大利亚癌症协会。
