比较中低收入国家和高收入国家儿童癌症的表现和结局：一项研究。
Comparing presentations and outcomes of children with cancer: a study between a lower-middle-income country and a high-income country.
机构信息
Department of Pediatric Oncology, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.
Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, University Hospital of Cologne, Cologne, Germany.
出版信息
BMC Pediatr. 2023 Sep 5;23(1):443. doi: 10.1186/s12887-023-04214-8.
BACKGROUND
Substantial progress has been achieved in managing childhood cancers in many high-income countries (HICs). In contrast, survival rates in lower-middle-income countries (LMICs) are less favorable. Here, we aimed to compare outcomes and associated factors between two large institutions; Egypt (LMIC) and Germany (HIC).
METHODS
A retrospective review was conducted on newly diagnosed children with cancer between 2006 and 2010 in the departments of pediatric oncology at the South Egypt Cancer Institute (SECI) (n = 502) and the University Hospital of Cologne-Uniklinik Köln (UKK) (n = 238). Characteristics including age, sex, diagnosis, travel time from home to the cancer center, the time interval from initial symptoms to the start of treatment, treatment-related complications, compliance, and outcome were analyzed. A Cox proportional hazards regression model was applied to investigate the influence of risk factors.
RESULTS
The most common diagnoses in SECI were leukemia (48.8%), lymphomas (24.1%), brain tumors (1%), and other solid tumors (24.7%), compared to 22.3%, 19.3%, 28.6%, and 26.5% in UKK, respectively. Patients from SECI were younger (5.2 vs. 9.0 years, P < 0.001), needed longer travel time to reach the treatment center (1.44 ± 0.07 vs. 0.53 ± 0.03 h, P < 0.001), received therapy earlier (7.53 ± 0.59 vs. 12.09 ± 1.01 days, P = 0.034), showed less compliance (85.1% vs. 97.1%, P < 0.001), and relapsed earlier (7 vs. 12 months, P = 0.008). Deaths in SECI were more frequent (47.4% vs. 18.1%) and caused mainly by infection (60% in SECI, 7% in UKK), while in UKK, they were primarily disease-related (79% in UKK, 27.7% in SECI). Differences in overall and event-free survival were observed for leukemias but not for non-Hodgkin lymphoma.
CONCLUSIONS
Outcome differences were associated with different causes of death and other less prominent factors.
背景
在许多高收入国家（HIC）中，儿童癌症的治疗已取得重大进展。相比之下，中低收入国家（LMIC）的生存率则不尽如人意。在此，我们旨在比较两家大型机构——埃及（LMIC）和德国（HIC）——的结果和相关因素。
方法
对 2006 年至 2010 年间在南埃及癌症研究所（SECI）（n=502）和科隆大学医院（UKK）（n=238）儿科肿瘤学系新诊断的癌症儿童进行了回顾性研究。分析了年龄、性别、诊断、从家到癌症中心的旅行时间、从最初症状到开始治疗的时间间隔、治疗相关并发症、依从性和结果等特征。应用 Cox 比例风险回归模型探讨了危险因素的影响。
结果
SECI 最常见的诊断为白血病（48.8%）、淋巴瘤（24.1%）、脑肿瘤（1%）和其他实体瘤（24.7%），而 UKK 分别为 22.3%、19.3%、28.6%和 26.5%。SECI 的患者年龄更小（5.2 岁比 9.0 岁，P<0.001），到达治疗中心所需的旅行时间更长（1.44±0.07 小时比 0.53±0.03 小时，P<0.001），接受治疗更早（7.53±0.59 天比 12.09±1.01 天，P=0.034），依从性较差（85.1%比 97.1%，P<0.001），复发较早（7 个月比 12 个月，P=0.008）。SECI 的死亡率更高（47.4%比 18.1%），主要由感染引起（SECI 中 60%，UKK 中 7%），而 UKK 中主要与疾病相关（UKK 中 79%，SECI 中 27.7%）。白血病患者的总体生存率和无事件生存率存在差异，但非霍奇金淋巴瘤患者不存在差异。
结论
不同的死亡原因和其他不那么明显的因素导致了结果的差异。
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