Dimitrios Doganis1, Paraskevi Panagopoulou2, Athanasios Tragiannidis3, Theodoros Vichos2, Maria Moschovi4, Sofia Polychronopoulou5, Efthimia Rigatou5, Eugenia Papakonstantinou6, Eftichia Stiakaki7, Helen Dana8, Panagiota Bouka2, Luis Antunes9, Joana Bastos10, Daniela Coza11, Anna Demetriou12, Domenic Agius13, Sultan Eser14, Anton Ryzhov15, Mario Sekerija16, Maciej Trojanowski17, Tina Zagar18, Anna Zborovskaya19, Snezana Zivkovic Perisic20, Katerina Strantzia21, Nick Dessypris2, Theodora Psaltopoulou2, Eleni Th Petridou22. 1. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Oncology Department, "P & A Kyriakouˮ Children's Hospital, Athens, Greece. 2. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece. 3. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece. 4. Pediatric Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, "Agia Sofiaˮ Children's Hospital, Athens, Greece. 5. Department of Pediatric Hematology-Oncology, "Agia Sofiaˮ Children's Hospital, Athens, Greece. 6. Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece. 7. Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece. 8. Pediatric Hematology-Oncology Department, "Miteraˮ Children's Hospital, Athens, Greece. 9. North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology, Porto, Portugal. 10. Registo Oncológico Regional Do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, Portugal. 11. Cluj Regional Cancer Registry, The Oncology Institute "Prof. Dr. Ion Chiricuţăˮ, Cluj-Napoca, Romania. 12. Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus. 13. Malta National Cancer Registry, Department for Policy in Health - Health Information and Research, Pieta, Malta. 14. Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe, University Institute of Public Health, Ankara, Turkey. 15. National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine & Taras Shevchenko National University of Kyiv, Ukraine. 16. Croatian Institute of Public Health, Croatian National Cancer Registry, Zagreb, Croatia; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia. 17. Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznan, Poland. 18. Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia. 19. Belarusian Research Center for Paediatric Oncology, Haematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus. 20. Institute of Public Health of Serbia, Central Serbia Cancer Registry, Dr Subotica 5, 11000, Belgrade Serbia. 21. Pathology Laboratory, "P & A. Kyriakouˮ Children's Hospital, Athens, Greece. 22. Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden. Electronic address: epetrid@med.uoa.gr.
Abstract
BACKGROUND: Despite recent therapeutic advancements, Wilms tumour (WT) presents remarkable survival variations. We explored mortality and survival patterns for children (0-14 years) with WT in 12 Southern and Eastern European (SEE) countries in comparison with the United States of America (USA). METHODS: A total of 3966 WT cases (0-14 years) were registered by a network of SEE childhood cancer registries (N:1723) during available registration periods circa 1990-2016 and surveillance, epidemiology, and end results program (SEER) (N:2243; 1990-2012); mortality data were provided by the respective national statistical services. Kaplan-Meier curves and Cox proportional hazards models were used to assess the role of age, sex, year of diagnosis, urbanisation and Human Development Index (HDI) on overall survival (OS). RESULTS: Persisting regional variations shape an overall 78% 5-year OS in the participating SEE countries, lagging behind the USA figure (92%, p=0.001) and also reflected by higher SEE mortality rates. Worth mentioning is the gradually escalating OS in SEE (hazard ratio [HR]5-year increment:0.67, 95% confidence interval [CI]:0.60, 0.75) vs. a non-significant 10% improvement in the SEER data, which had a high starting value. OS differentials [two-fold less favourable among children aged 10-14 years, boys and those living in rural SEE areas (HR:1.37; CI:1.10-1.71) or countries with inferior HDI (2-3-fold)] were minimal in the USA. CONCLUSIONS: Children with WT residing in SEE countries do not equally enjoy the substantial survival gains, especially for those living in rural areas and in lower HDI countries. Noteworthy are steep and sizeable survival gains in SEE along with the newly presented Greek data pointing to achievable survival goals in SEE despite the financial crisis.
BACKGROUND: Despite recent therapeutic advancements, Wilms tumour (WT) presents remarkable survival variations. We explored mortality and survival patterns for children (0-14 years) with WT in 12 Southern and Eastern European (SEE) countries in comparison with the United States of America (USA). METHODS: A total of 3966 WT cases (0-14 years) were registered by a network of SEE childhood cancer registries (N:1723) during available registration periods circa 1990-2016 and surveillance, epidemiology, and end results program (SEER) (N:2243; 1990-2012); mortality data were provided by the respective national statistical services. Kaplan-Meier curves and Cox proportional hazards models were used to assess the role of age, sex, year of diagnosis, urbanisation and Human Development Index (HDI) on overall survival (OS). RESULTS: Persisting regional variations shape an overall 78% 5-year OS in the participating SEE countries, lagging behind the USA figure (92%, p=0.001) and also reflected by higher SEE mortality rates. Worth mentioning is the gradually escalating OS in SEE (hazard ratio [HR]5-year increment:0.67, 95% confidence interval [CI]:0.60, 0.75) vs. a non-significant 10% improvement in the SEER data, which had a high starting value. OS differentials [two-fold less favourable among children aged 10-14 years, boys and those living in rural SEE areas (HR:1.37; CI:1.10-1.71) or countries with inferior HDI (2-3-fold)] were minimal in the USA. CONCLUSIONS:Children with WT residing in SEE countries do not equally enjoy the substantial survival gains, especially for those living in rural areas and in lower HDI countries. Noteworthy are steep and sizeable survival gains in SEE along with the newly presented Greek data pointing to achievable survival goals in SEE despite the financial crisis.