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2017 ; 4
(5
): e202-e217
Nephropedia Template TP
gab.com Text
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English Wikipedia
Worldwide comparison of survival from childhood leukaemia for 1995-2009, by
subtype, age, and sex (CONCORD-2): a population-based study of individual data
for 89?828 children from 198 registries in 53 countries
#MMPMID28411119
Bonaventure A
; Harewood R
; Stiller CA
; Gatta G
; Clavel J
; Stefan DC
; Carreira H
; Spika D
; Marcos-Gragera R
; Peris-Bonet R
; Piņeros M
; Sant M
; Kuehni CE
; Murphy MFG
; Coleman MP
; Allemani C
Lancet Haematol
2017[May]; 4
(5
): e202-e217
PMID28411119
show ga
BACKGROUND: Global inequalities in access to health care are reflected in
differences in cancer survival. The CONCORD programme was designed to assess
worldwide differences and trends in population-based cancer survival. In this
population-based study, we aimed to estimate survival inequalities globally for
several subtypes of childhood leukaemia. METHODS: Cancer registries participating
in CONCORD were asked to submit tumour registrations for all children aged 0-14
years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009,
and followed up until Dec 31, 2009. Haematological malignancies were defined by
morphology codes in the International Classification of Diseases for Oncology,
third revision. We excluded data from registries from which the data were judged
to be less reliable, or included only lymphomas, and data from countries in which
data for fewer than ten children were available for analysis. We also excluded
records because of a missing date of birth, diagnosis, or last known vital
status. We estimated 5-year net survival (ie, the probability of surviving at
least 5 years after diagnosis, after controlling for deaths from other causes
[background mortality]) for children by calendar period of diagnosis (1995-99,
2000-04, and 2005-09), sex, and age at diagnosis (<1, 1-4, 5-9, and 10-14 years,
inclusive) using appropriate life tables. We estimated age-standardised net
survival for international comparison of survival trends for precursor-cell acute
lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML). FINDINGS: We
analysed data from 89?828 children from 198 registries in 53 countries. During
1995-99, 5-year age-standardised net survival for all lymphoid leukaemias
combined ranged from 10·6% (95% CI 3·1-18·2) in the Chinese registries to 86·8%
(81·6-92·0) in Austria. International differences in 5-year survival for
childhood leukaemia were still large as recently as 2005-09, when
age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI
42·8-61·9) in Cali, Colombia, to 91·6% (89·5-93·6) in the German registries, and
for AML ranged from 33·3% (18·9-47·7) in Bulgaria to 78·2% (72·0-84·3) in German
registries. Survival from precursor-cell ALL was very close to that of all
lymphoid leukaemias combined, with similar variation. In most countries, survival
from AML improved more than survival from ALL between 2000-04 and 2005-09.
Survival for each type of leukaemia varied markedly with age: survival was
highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than
1 year). There was no systematic difference in survival between boys and girls.
INTERPRETATION: Global inequalities in survival from childhood leukaemia have
narrowed with time but remain very wide for both ALL and AML. These results
provide useful information for health policy makers on the effectiveness of
health-care systems and for cancer policy makers to reduce inequalities in
childhood cancer survival. FUNDING: Canadian Partnership Against Cancer, Cancer
Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK, US
Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research
foundation, Swiss Cancer League, and the University of Kentucky.