Cancer survival among children and adolescents at a state
               referral hospital in southeastern Brazil

Zouain-Figueiredo, Gláucia Perini; Zandonade, Eliana; Amorim, Maria Helena Costa

doi:10.1590/S1519-38292013000400006

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ORIGINAL ARTICLES • Rev. Bras. Saude Mater. Infant. 13 (4) • Oct-Dec 2013 • https://doi.org/10.1590/S1519-38292013000400006 copy

Cancer survival among children and adolescents at a state referral hospital in southeastern Brazil

Sobrevida do câncer em crianças e adolescentes em hospital de referência estadual na região sudeste do Brasil

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

to analyze the patient characteristics and evaluate overall survival, survival according to demographic variables, the most common tumor groups and subgroups, the stages of disease, and risk factors after at least 5 years among children and adolescents with cancer who were admitted to a state referral hospital between 2000 and 2005.

METHODS:

the Kaplan-Meier method was employed to estimate survival. The survival curves were compared using the log-rank test. The Cox regression model was used to estimate the effect of independent variables.

RESULTS:

a total of 571 new cases were registered. The most frequent cancer groups were leukemia (34%), lymphoma (18%), and central nervous system (CNS) tumors (15%).The overall survival rate was 59%. The risk factors associated with lower survival were an age of more than 4 years or less than 1 year, the presence of CNS tumors, and non-localized disease.

CONCLUSION:

although this was not a populationbased study, it provides important epidemiological information about a state where population data on childhood and adolescent cancer are scarce and where hospital-based data do not exist. The survival rate found here should serve as a framework for future improvements, helping to guide policymakers focused on pediatric oncology in the state.

Cancer; Children; Adolescents; Survival analysis

Clinical-epidemiological variables		N	%	Survival time (in months)				p-value
Clinical-epidemiological variables		N	%	Deaths	Mean	95% LL	95% UL	p-value
Sex
	Female	276	48,0	107	88.8	81.5	96.1	0.078
	Male	295	52,0	140	75.6	68.7	82.5
Age group (in years)
	0 \|-- 1	41	7,0	18	79.5	60.9	98.1	0.011
	1 \|-- 5	191	34,0	68	87.5	79.3	95.7
	5 \|-- 10	151	26,0	61	87.9	78.2	97.7
	10 \|-- 15	137	24,0	74	63.2	54.2	72.1
	15 \|-- 19	51	9,0	26	68.0	52.2	83.9
Region of origin
Espírito Santo
	North	72	13,0	35	69.3	56.9	81.6	0.605
	Central	77	13,0	30	87.3	74.4	100.2
	Metropolitan	296	52,0	130	82.3	75.1	89.5
	South	63	11,0	29	73.3	59.0	87.7
Other States		63	11,0	23	81.9	68.8	95.0
Most common ICCC-3 groups
	I Leukemia	194	34,0	87	76.7	68.7	84.7	0.001
	II Lymphoma	101	18,0	23	96.2	86.9	105.5
	III CNS tumors	84	15,0	45	62.2	49.7	74.8
	IV-XII Other	192	33,0	92	77.4	68.1	86.8
	I-XII Total	571	100,0	247	82.7	77.3	88.1
Most common ICCC-3 subgroups (n=415)
	I (a) Acute lymphocytic leukemia	141	^* * Proportion in relation to the reference group; 73,0	58	82.8	73.8	91.7	0.001
	I (b) Acute myeloid leukemia	42	^* * Proportion in relation to the reference group; 22,0	24	57.2	38.9	75.4
	II (a) Hodgkin's lymphoma	31	^* * Proportion in relation to the reference group; 31,0	4	89.6	81.9	97.3
	II (b) Non-Hodgkin's and non-Burkitt's lymphoma	23	^* * Proportion in relation to the reference group; 23,0	7	88.8	68.3	109.3
	II (c) Burkitt's lymphoma	30	^* * Proportion in relation to the reference group; 30,0	11	69.5	51.4	87.6
	III (b) Astrocytoma	30	^* * Proportion in relation to the reference group; 36,0	13	75.4	55.0	95.7
	IV (a) Neuroblastoma	26	^* * Proportion in relation to the reference group; 90,0	17	48.8	32.0	65.7
	VI (a) Nephroblastoma	47	^* * Proportion in relation to the reference group; 87,0	8	114.2	102.2	126.2
	VIII (a) Osteosarcoma	23	^* * Proportion in relation to the reference group; 70,0	10	73.4	54.7	92.1
	IX (a) Rhabdomyosarcoma	22	^* * Proportion in relation to the reference group; 61,0	14	58.8	36.1	81.6
Extent of disease ^† † In total, 278 cases of leukemia and CNS tumors were excluded. No information was available for seven patients. (n=286)
Local		105	37,0	22	111.2	100.9	121.6	0.001
Regional		98	34,0	37	84.0	72.4	95.5
Metastatic		83	29,0	50	54.6	43.9	65.3

Subgroup - ICCC-3	N	Time since diagnosis
Subgroup - ICCC-3	N	3 months	6 months	12 months	24 months	36 months	48 months	60 months
I (a) Acute lymphocytic leukemia	141	87.9	86.5	80.1	73.0	67.4	63.1	62.4
I (b) Acute myeloid leukemia	42	66.7	61.9	50.0	47.6	47.6	45.2	42.9
II (a) Hodgkin's lymphoma	31	100.0	100.0	100.0	96.8	93.5	90.3	90.3
II (b) Non-Hodgkin's and non-Burkitt's lymphoma	23	100.0	95.7	87.0	73.9	73.9	69.6	69.6
II (c) Burkitt's lymphoma	30	76.7	70.0	63.3	63.3	63.3	63.3	63.3
III (b) Astrocytoma	30	90.0	90.0	86.7	73.3	66.7	66.7	63.3
IV (a) Neuroblastoma	26	96.2	88.5	76.9	50.0	38.5	34.6	34.6
VI (a) Nephroblastoma	47	97.9	97.9	97.9	89.4	87.2	85.1	83.0
VIII (a) Osteosarcomas	23	100.0	95.7	87.0	69.6	69.6	60.9	60.9
IX (a) Rhabdomyosarcoma	22	95.5	86.4	72.7	54.5	54.5	45.5	40.9
Total	415	89.1	85.3	78.3	68.3	64.3	60.1	59.0

Clinical-epidemiological variables		N	Unadjusted hazard ratio				Cox adjusted hazard ratio (N=286)
Clinical-epidemiological variables		N	p-value	estimate	95% LL	95% UL	p-value	estimate	95% LL	95% UL
Sex			0.080				0.013
	Female	276		1				1
	Male	295		1.25	0.97	1.6		1.39	1.07	1.81
Age group (in years)			0.014				0.003
	0 \|-- 1	41		1.34	0.79	2.25		1.68	0.99	2.87
	1 \|-- 5	191		1				1
	5 \|-- 10	151		1.15	0.81	1.63		1.37	0.96	1.96
	10 \|-- 15	137		1.72	1.23	2.29		1.96	1.39	2.77
	15 \|-- 19	51		1.63	1.04	2.57		1.64	1.02	2.84
Most frequent ICCC-3 groups			0.001				0.001
	Lymphoma	101		1				1
	Leukemia	194		2.15	1.35	3.4		6.75	0.87	51.86
	CNS tumors	84		3.03	1.83	5.01		9.11	1.18	70.55
	Other	192		2.28	1.44	3.6		3.45	2.13	5.62
Extent of disease^* * In total, 278 cases of leukemia and CNS tumors were excluded. The extent of disease data for seven patients could not be obtained from the medical records.			0.001				0.001
	Local	105		1				1
	Regional	98		2.10	1.24	3.56		2.64	1.55	4.51
	Metastatic	83		4.01	2.42	6.65		4.47	2.68	7.46

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[1] ICCC-3= International Classification of Childhood Cancer, 3^rd version;

[t01-fn01] ^*
Proportion in relation to the reference group;

[t01-fn02] ^†
In total, 278 cases of leukemia and CNS tumors were excluded. No information was available for seven patients.