Incidence and survival in children and adolescents from ...€¦ · Incidence and survival in children and adolescents from 1967 to 2011: Childhood Cancer Registry of Piedmont Manasievska

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.