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Incidence and survival in children and
adolescents from 1967 to 2011:
Childhood Cancer Registry of Piedmont
Manasievska M1, Isaevska E1, Alessi D1, Mosso ML1, Sacerdote C1, Terracini B1, Merletti F1, Buzzoni C2,3, Maule M1
1. Childhood Cancer Registry of Piedmont, University of Turin
2. AIRTUM
3. ISPO, Florence
13-15 Aprile 2016Reggio Children c/o Centro Internazionale Loris Malaguzzi – REGGIO EMILIA
Several papers have reported Several papers have reported childhood cancer childhood cancer
increases increases world wideworld wide
Survival is one of the most important indicator of
the quality of care quality of care for for cancer patientscancer patients
INTRODUCTION
To provide updated information on To provide updated information on
cancer incidence and survival in cancer incidence and survival in
children and adolescents based on children and adolescents based on
data from the Childhood Cancer data from the Childhood Cancer
Registry of Piedmont (CCRP)Registry of Piedmont (CCRP)
OBJECTIVES OF THE STUDY
MATERIALS AND METHODS
• CCRP: the oldest and largest pediatric population-based Cancer
Registry in Italy
• Quality of data collected by the CCRP has been uniformly high
• Data collection:
• Since 1967: incident cases of cancer in children
• Since 2000: incident cases in adolescent
• Site, morphology and behavior: ICD-0-3
• 12 tumor types grouped according to the International
Classification of Childhood Cancer (ICCC)
• All malignant cerebral tumors and intracranial neoplasms of
benign histology included
MATERIALS AND METHODS
� Incidence rates- per million children per year - for children and adolescents- resident in Piedmont- gender: M, F, MF- age classes: 0, 1-4, 5-10, 10-14, 0-14, 15-19, 0-19- ICCC diagnostic categories
� Incidence time trends- whole period (1976-2011)- most recent period (2000-2011)- APC: annual percent change- Joinpoint regression on world age-standardized incidence rates
MATERIALS AND METHODS
�Kaplan-Meier method used to estimate
cumulative survival percentages
�Cohort method
– 9 consecutive 5-year diagnosis cohorts (1967-
71, 1972-76…) until 2011 for children
– 2 consecutive 6-year diagnostic cohorts
starting from 2000 until 2011 for adolescents
(15-19 years)
Statistical analysis - survival
020
4060
Rat
e (p
er m
ilion
)
1970 1980 1990 2000 2010Year
Incidence rates (per million) 1967Incidence rates (per million) 1967--20112011. . Children aged 0Children aged 0--1414
LymphomaNeuroblastomaRenal tumors
LeukemiaCNSRetinoblastoma
RetinoblastomaHepatic tumorsSoft-tissue sarcomasCarcinoma
Bone tumorsGerm cellOther
LEUKEMIA 51.2 LEUKEMIA 51.2
CNS TUMORS 36.7CNS TUMORS 36.7
LYMPHOMA 18.7LYMPHOMA 18.7 NEUROBLASTOMA 11.8NEUROBLASTOMA 11.8
RESULTS
050
100
150
Rat
e (p
er m
ilion
)
2000 2005 2010Year
Incidence rates (per million) 2000-2011.Adolescents aged 15-19
LymphomaNeuroblastomaRenal tumors
LeukemiaCNSRetinoblastoma
LYMPHOMA 89.7LYMPHOMA 89.7
CARCINOMAS 55.5CARCINOMAS 55.5
LEUKEMIA 35.2LEUKEMIA 35.2
CNS TUMORS 37.5CNS TUMORS 37.5
Hepatic tumorsSoft-tissue sarcomasCarcinoma
Bone tumorsGerm cellOther
RESULTS
050
100
150
Rat
e (p
er m
ilion
)
0 5 10 15 20Age
Incidence rates (per million) 1967Incidence rates (per million) 1967--20112011 by tumor type and age of diagnosisby tumor type and age of diagnosis
LeukemiaCNSRetinoblastomaHepatic tumors
LymphomaNeuroblastomaRenal tumorsBone tumors
RetinoblastomaHepatic tumorsSoft-tissue sarcomasCarcinomaEmbryonal
Bone tumorsGerm cellOther
Embryonal
LEUKEMIALEUKEMIA
(1(1--4 age group)4 age group)
LYMPHOMALYMPHOMA
(15(15--19 age group)19 age group)
NEUROBLASTOMANEUROBLASTOMA
(0 age group)(0 age group)
CARCINOMASCARCINOMAS
(15(15--19) age group19) age group
EMBRYONAL TUMORSEMBRYONAL TUMORS
(0 age group)(0 age group)
RESULTS
RESULTS
ICCC
Trend analysis for the whole period (1976-2011)
Trend analysis for the more recent period(2000-2011)
APC APC
All tumor types 1.11 (0,8;1.5) 0.82 (-1.9;3.7)
Leukemia 0.64 (0,0; 1.2) -0.67 (-5.4;4.5)
Lymphomas1.67 (0.6;2.7)
-1.41 (-6.8;4.3)-12.20 (33.2;15.4)
CNS tumors 1.95 (1.3;2.6) 0.27 (-4.5;4.2)
Neuroblastoma 1.19 (0.2;2.1) -2.36 (-7.0;2.5)
1976-2007
2007-2011
RESULTS
p value<0.0001
0
10
20
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-19811982-1986 1987-1991 1992-19961997-2001 2002-2006 2007-2011
Lymphoid Leukemia
p value<0.0001
20
0
10
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
Acute Myeloid Leukemia
Cumulative survival by 5-year cohorts of diagnosis in children
p value<0.0001
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
Hodgkin disease
p value<0.0001
10
20
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
Non-Hodgin Lymphoma
RESULTS
Cumulative survival by 5-year cohorts of diagnosis in children
RESULTS
p value<0.0001
20
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
Central Nervous System Tumors
p value<0.0001
10
20
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
Neuroblastoma and ganglioneuroblastoma
Cumulative survival by 5-year cohorts of diagnosis in children
RESULTS
20
30
40
50
60
70
80
90
100
0 5 10 15 20 25 30 35 40 45
Years from diagnosis
1967-1971 1972-1976 1977-1981
1982-1986 1987-1991 1992-1996
1997-2001 2002-2006 2007-2011
All Tumor types
p value=0.0418
80
82
84
86
88
90
92
94
96
98
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13Years from diagnosis
2000-2005 2006-2011
All Tumor Types
Cumulative survival by 5-year cohorts of diagnosis in children
Cumulative survival by 6-year cohorts of diagnosis in adolescents
CONCLUSIONS - INCIDENCE
�Trends for the whole period: statistically significant
increases for several tumor types
� Trends for the most recent period: dominated by
very large variation in incidence rates
� There is still no satisfactory explanation for the
observed increase of the incidence in the past, so we
should focus on finding what is behind this increase
CONCLUSIONS - SURVIVAL
� Positive trend in survival after childhood and
adolescence cancer in recent years in Piedmont �
cancer registration important monitor of survival at
the population level.
�Adolescents have sometimes poor prognoses: “big
children” or “small adults”. Improvements in
survivals might occur after the development of
specifically studied protocols for the treatment of
this vulnerable group of patients.