Groupe Franco-Africain d'Oncologie Pédiatrique (GFAOP) Gustave Roussy Villejuif, Villejuif, France.
Service d'oncologie pédiatrique, Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, Burkina Faso.
Pediatr Blood Cancer. 2023 Dec;70(12):e30664. doi: 10.1002/pbc.30664. Epub 2023 Sep 21.
The improvement of childhood cancer outcome is determined by early diagnosis, effective treatment, supportive care, and adequate medical follow-up. Stage at diagnosis may reflect timeliness of diagnosis, therefore standardized registration of stage is essential for interpretation of regional differences and time trends in survival. Here, we describe the feasibility of implementing the Toronto Childhood Cancer Stage Guidelines (hereafter Toronto Guidelines [TG]) in the hospital-based cancer registry of the Franco-African Pediatric Oncology Group (GFAOP), and assess the impact of TG stage on outcome in pediatric oncology units (POUs) in seven low- and middle-income countries in sub-Saharan Africa (SSA).
All cancer patients diagnosed before 15 years of age with one of the 15 cancer types defined in TG, resident in one of the participating countries, and attending one of the selected POUs in 2017-2019 were included. Stage was assigned according to TG. Patients were followed-up for vital status for at least 12 months post diagnosis. Survival at 3, 6, and 12 months was calculated using Kaplan-Meier method and compared between POUs and tumor groups using log-rank test.
TG stage was assigned to 1772 of 2446 (89%) cases diagnosed with one of 11 cancer types. It was not possible to assign TG stage to acute lymphoblastic leukemia (ALL) and the three types of the central nervous system tumors included in the TG. One-year overall survival (OS) was 58% [95% confidence interval: 55-60] and varied between POUs. Survival declined with increasing stage for four tumor types and was statistically significant for two.
Except for ALL and brain tumors, we demonstrated feasibility of TG implementation for childhood solid cancers in participating POUs in SSA, and provided a baseline assessment of childhood cancer outcomes against which future stage distribution and survival can be measured as timelines of diagnosis improve over time within the GFAOP network.
儿童癌症结局的改善取决于早期诊断、有效治疗、支持性护理和充分的医疗随访。诊断时的分期可能反映诊断的及时性，因此标准化登记分期对于解释区域差异和生存时间趋势至关重要。在这里，我们描述了在法非儿科肿瘤组（GFAOP）的基于医院的癌症登记处实施多伦多儿童癌症分期指南（以下简称多伦多指南 [TG]）的可行性，并评估了 TG 分期对撒哈拉以南非洲（SSA）七个中低收入国家儿科肿瘤病房（POU）的儿童肿瘤结局的影响。
所有在 2017-2019 年期间被诊断为年龄在 15 岁以下且患有 TG 中定义的 15 种癌症之一、居住在参与国之一、并在选定的 POU 之一就诊的癌症患者均被纳入研究。根据 TG 进行分期。对患者进行至少 12 个月的生存随访。使用 Kaplan-Meier 法计算 3、6 和 12 个月的生存率，并使用对数秩检验比较 POU 和肿瘤组之间的生存率。
1772 例（89%）诊断为 11 种癌症之一的病例被分配了 TG 分期。急性淋巴细胞白血病（ALL）和 TG 中包含的三种中枢神经系统肿瘤无法进行 TG 分期。1 年总生存率（OS）为 58%[95%置信区间：55-60]，且在 POU 之间存在差异。四种肿瘤类型的生存率随分期的增加而下降，其中两种具有统计学意义。
除 ALL 和脑肿瘤外，我们证明了 TG 对 SSA 参与 POU 中儿童实体瘤实施的可行性，并提供了儿童癌症结局的基线评估，以便随着 GFAOP 网络中诊断时间的延长，未来可以根据分期分布和生存率进行衡量。
