Krischer J P, Roush S W, Cox M W, Pollock B H
Department of Pediatrics, University of Florida, Gainesville.
Cancer. 1993 May 15;71(10 Suppl):3331-6. doi: 10.1002/1097-0142(19930515)71:10+<3331::aid-cncr2820711732>3.0.co;2-s.
Unlike cancers occurring in adults, childhood cancers are distinguished by being primarily nonepithelial in origin and by their relative rarity. Even with the availability of registries such as the Surveillance, Epidemiology and End Results program of the National Cancer Institute or the Florida Cancer Data System for the State of Florida, there are potential biases that may affect the estimates of pediatric cancer incidence, studies related to elucidating patterns of care, and other epidemiologic studies.
To evaluate the magnitude of these potential biases and elucidate the settings (pediatric cancer center versus non-cancer center) in which childhood cancers are treated, the authors performed a retrospective study of childhood cancer in Florida.
Approximately 19% of childhood cancer cases (in patients 0-19 years of age) in Florida diagnosed from 1981 to 1986 were treated outside of identified pediatric cancer centers in the state. Children with Hodgkin disease and brain tumors represented 43% of these cases. Among those cases treated in pediatric cancer centers, 23% were treated by physicians other than pediatric oncologists. Children with brain tumors represented 28% of these cases. Of those treated by pediatric oncologists, 65% were eligible for a cooperative group protocol and 55% of these were enrolled.
Population-based registries are necessary for describing the full extent of childhood cancer, but they have limitations in demonstrating patterns of care. Consequently, generalization from the experience of pediatric cancer centers is questionable, and the opportunity to test and achieve advances in diagnosis and treatment may be subject to selection bias.
与成人癌症不同，儿童癌症的特点是主要起源于非上皮组织且相对罕见。即使有诸如美国国立癌症研究所的监测、流行病学和最终结果计划或佛罗里达州的佛罗里达癌症数据系统等登记处，仍可能存在一些偏差，这些偏差可能会影响儿童癌症发病率的估计、与阐明治疗模式相关的研究以及其他流行病学研究。
为了评估这些潜在偏差的程度，并阐明治疗儿童癌症的机构（儿科癌症中心与非癌症中心），作者对佛罗里达州的儿童癌症进行了一项回顾性研究。
1981年至1986年在佛罗里达州诊断出的儿童癌症病例（0至19岁患者）中，约19%在该州已确定的儿科癌症中心以外接受治疗。霍奇金病和脑肿瘤患儿占这些病例的43%。在儿科癌症中心接受治疗的病例中，23%由儿科肿瘤学家以外的医生治疗。脑肿瘤患儿占这些病例的28%。在由儿科肿瘤学家治疗的病例中，65%符合合作组方案的条件，其中55%登记入组。
基于人群的登记对于描述儿童癌症的全貌是必要的，但在展示治疗模式方面存在局限性。因此，从儿科癌症中心的经验进行推广是值得怀疑的，并且在诊断和治疗方面进行测试和取得进展的机会可能会受到选择偏差的影响。
