Factors associated with 5- and 10-year survival among a recent cohort of childhood cancer survivors (France, 2000-2015)

Improve Cure Rate of Children with Retinoblastoma: The AMCC Programme in Sub-Saharan Africa

Alliance Mondiale Contre le Cancer (AMCC) is a non-profit French association devoted to improving cancer care in poor countries. It is domiciled at Institut Curie (Paris, France), which is the multidisciplinary referent retinoblastoma (RB) centre in France. In sub-Saharan Africa the number of children with RB is high (about 2 000 out of 8 500 worldwide) as 40% of the population is less than 15 years old and the population growth rate is still 2.7% versus 1.1% for the whole world. Few health facilities were able to treat retinoblastoma in 2010. Diagnosis was often not possible or too late and mortality was high (over 80%) compared to Europe or the USA (mortality less than 5% since decades). Since 2011 we have started with the team in Bamako (Mali) a programme to develop the care for RB in sub-Saharan Countries. Demonstration was obtained that the situation could improve with some specific support. Since 2019, a 10-year programme (2019-2029) was initiated in sub-Saharan countries including training of ophthalmologists and ocularists, development of multidisciplinary teams (MDTs) with paediatric-oncologists, the supply of complementary ophthalmological equipment to allow conservative management in bilateral cases, support for chemotherapy in some countries, data collections and publications and early diagnosis actions. To-day, halfway through the programme's deployment, it is supporting 30 teams in 23 countries: French speaking and some English and Portuguese speaking countries. Efforts will continue over the next 5 years to improve sustainably early diagnosis with the aim of curing at least 60% of all children with RB in 2030 with preservation of a useful vision for most of the bilateral cases.

Epidemiology, incidence, and outcome of childhood cancers in the Afro-descendant population of the French West Indies and French Guiana: a population-based study

Background

The epidemiology of childhood cancer in Afro-descendant (AD) populations is poorly described. We performed a descriptive study of the distribution, incidence, and survival of children with cancer in the French West Indies (FWI) and French Guiana (FG).

Methods

We included all patients aged 0-17 diagnosed with cancer or benign intracranial tumor between January 2011 and December 2021 and living in the FWI/FG area at time of diagnosis. The cases were identified from the French national registry of childhood cancer and cross-referenced with local sources. Incidence rates were calculated, and compared to that of mainland France by standardized incidence ratios (SIR). Vital status was completed up to the 31st of December 2023 (date of point). Relapses were identified and documented in pediatric reference centers in mainland France and local centers. The 5-year overall survival (5yOS) and event-free survival (5yEFS) were estimated using Kaplan-Meier method.

Findings

We identified 368 patients (26% leukemias, 21% central nervous system tumors, 12% lymphomas, and 41% others). The average age at diagnosis was 8.8 years (Range: 0.1-17.8), with 52% boys. The median follow-up was 4.4 years (Range: 0.1-12.3). The age standardized rates for all cancers was lower than in mainland France (124.9 vs 162.6 per million-year for children under 18 years old, SIR = 0.77 [95% CI: 0.69-0.85]). The 5yOS was 78.9% [95% CI: 73.9-83.0] and 5yEFS was 69.3% [95% CI: 63.9-74.0]. The 5yOS for the 0-14 age group was 81.2% [95% CI: 76.9-85.5].

Interpretation

This first registry-based study of childhood cancer in the FWI and FG shows that our patients with childhood cancer, treated in a country with a high standard of health care, has resulted in overall survival comparable to that of European and North American children.

Funding

The authors received no financial support.

Expression evaluated by digital image analysis techniques of PRAME more than MCM6 is associated with poor prognosis in neuroblastoma: A pilot study with 84 cases

Neuroblastoma is a common childhood tumor originating from neural crest progenitors with variable clinical behavior. Despite improved overall survival, factors such as stage, histoprognosis, MYCN status, and age still influence outcome. MCM6 regulates DNA replication and contributes to cancer progression. PRAME, first identified in melanoma, also acts on cell replication, epithelial-mesenchymal transition, and cell migration and has been associated with poor outcomes in several cancers, including neuroblastoma, using molecular biology techniques. The study aims to investigate MCM6 and PRAME expression and prognostic roles in neuroblastoma. A retrospective study was conducted, which included data of 84 patients with neuroblastoma diagnosed between 2000 and 2022, sourced from the pediatric tumor registry. Patient's characteristics and prognostic tumor factors were collected. Expression of MCM6 and PRAME proteins was evaluated using digital image analysis techniques. Univariate and multivariate analyses were performed using Cox regression to assess the impact of protein expression on survival and their associations with these prognostic factors. A total of 84 children diagnosed with neuroblastoma were included. MCM6 and PRAME were associated with unfavorable histologies (p = 0.03). PRAME was associated with bone marrow metastases (p < 0.01), high mitotic-karyorrhectic index (p = 0.04), and poor histoprognosis (p < 0.01). PRAME and MCM6 expression was correlated with several neuroblastoma prognostic factors. PRAME was significantly (p = 0.05) associated with poor event-free survival (EFS) and not significantly (p = 0.08) associated with overall survival (OS). Although statistical significance was not reached in multivariate analysis, the trends strongly suggested that the overexpression of MCM6 and PRAME was correlated with decreased survival.

Patterns of Childhood Cancer Mortality in Hungary Since the Turn of the Millennium, Including the Two Years of the COVID-19 Pandemic

Objectives: We aimed to analyse the pattern of childhood cancer mortality among children under 15 years in Hungary between 2001 and 2021. In addition, annual and cyclical trends were examined. Methods: The number of deaths was obtained from the nationwide population register over the study period by gender, age group, and region for each year. Data were analysed using the Poisson regression method and cyclic trends were investigated using the Walter-Elwood method. Results: Overall, 14,931 childhood deaths (1092 from cancers) were registered between 2001 and 2021. The cancer mortality risk was significantly higher among boys than girls. A significantly decreasing trend was detected for yearly childhood cancer mortality rates, with an annual IRR of 0.976 (95% CI: 0.966-0.986; p < 0.001). This tendency was not influenced by the pandemic. However, different patterns of seasonal variation were revealed in childhood cancer mortality rates during 2020-2021 and 2001-2019. Conclusions: The annual trend in childhood cancer mortality was not affected by the coronavirus pandemic. However, there was a different pattern of childhood cancer mortality during the pandemic and non-pandemic period in Hungary. Considering the seasonal variation in monthly childhood cancer mortality rates, we hypothesized that environmental factors might play an important role in the aetiology of childhood cancer deaths.

Clinical impact of large genomic explorations at diagnosis in 198 pediatric solid tumors: a monocentric study aiming practical feasibility of precision oncology

INTRODUCTION

Faced to the growing development of collecting systematic molecular analyses in relapsed pediatric cancers to transform their targeted matched therapies, this study aimed to assess the clinical and therapeutic indications of systematic diagnostic genomic explorations performed in pediatric solid cancers to determine which type of screening and if it afford at relapse time an accurate targeted strategy.

METHODS

A total of 280 patients less than 22 years, referred at the University Hospitals of Strasbourg for a newly diagnosed solid tumor from January 2015 to December 2021, were prospectively genomically investigated since diagnosis. Using 7 different molecular tests going from single-gene methods (IHC, FISH, RT-PCR, Sanger sequencing, droplet digital PCR) to largescale analyses (Next-Generation sequencing, RNAsequencing and FoundationOne®CDx), we explored retrospectively the molecular findings in those pediatric solid tumors (except hematolymphoid cancers) to improve diagnosis, prognosis assessment and relapse therapeutics.

RESULTS

One hundred and ninety-eight patients (71%) underwent molecular biology (MB) at diagnosis. Thirty-eight different histologies were grouped into cerebral tumors (30%), sarcomas (26%, bone and soft tissues), various blastomas (27%), and other entities (17%). Over a median 40-month follow-up, the overall survival rate of patients was 85% and the relapse rate 28%. Of the 326 analyses carried out, 245 abnormalities (single nucleotide variations: 50%, fusions: 25%, copy number alteration: 20%) concerning 70 oncogenes were highlighted. The overall clinical impact rate was 84%. Broad-spectrum analyses had a higher therapeutic impact (57%) than the targeted analyses (28%). 75% of broad-spectrum tests found an actionable variant conducting 23% of patients to receive rapidly a matched targeted therapy since first relapse.

CONCLUSION

Our experience highlighted the clinical utility of molecular profiling of solid tumors as soon as at diagnosis in children to expect improving access to innovative agents at relapse.

A software tool to support follow-up care in a French childhood cancer cohort: construction and feasibility

BACKGROUND

Treatment summaries and a personalized survivorship care plans based on internationally approved, organ-specific follow-up care recommendations are essential in preserving the health and quality of life for cancer survivors. Cohorts made up of survivors of childhood cancer have made significant contributions to the understanding of early mortality, somatic late complications, and psychosocial outcomes among former patients. New treatment protocols are needed to enhance survival and reduce the potential risk and severity of late effects, and working with treatment databases is crucial in doing so.

CONSTRUCTION AND CONTENT

In the GOCE (Grand Ouest Cancer de l'Enfant [Western Region Childhood Cancer]) network, in a participative approach, we developed the LOG-after medical tool, on which health data are registered and can be extracted for analysis. Its name emphasizes the tool's goal, referring to 'logiciel' (the French word for software) that focuses on the period "after" the acute phase. This tool is hosted on a certified health data server. Several interfaces have been developed that can be used depending on the user's profile. Here we present this innovative co-constructed tool that takes national aspects into account, including the results of the feasibility/satisfaction study and its perspective.

UTILITY AND DISCUSSION

The database contains data relating to 2558 patients, with samples from 1702 of these (66.54%) being held in a tumor bank. The average year in which treatment started was 2015 (ranging from December 1967 to November 2022: 118 patients were treated before 2012 and registered retrospectively when seen in long-term follow-up consultations or for another cancer since November 2021). A short questionnaire was distributed to healthcare professionals using the tool (physicians and research associates or technicians, n = 14), of whom 11 answered and were all satisfied. Access to the patient interface is currently open to 124 former patients. This was initially offered to 30 former patients who were over 15 years old, affected by the disease within the last 5 years, and had agreed to test it. Their opinions were collected by their doctor by e-mail, telephone, or during a consultation in an open-ended question and a non-directive interview. All patients were satisfied with the tool, with interest in testing it in the long term. Some former patients found that the tool provided them with some ease of mind; one, for instance, commented: "I feel lighter. I allow myself to forget. I know I will get a notification when the time comes."

CONCLUSIONS

Freely available to all users, LOG-after: (1) provides help with determining personalized survivorship care plans for follow-up; (2) builds links with general practitioners; (3) empowers the patient; and (4) enables health data to be exported for analysis. Database URL for presentation: https://youtu.be/2Ga64iausJE.

PAX-FOXO1 fusion status in children and adolescents with alveolar rhabdomyosarcoma: Impact on clinical, pathological, and survival features

BACKGROUND

Alveolar rhabdomyosarcoma (ARMS) is an aggressive pediatric cancer and cases with fusion PAX3-FOXO1 and PAX7-FOXO1 seem to have a poor prognosis. The aim is to evaluate whether PAX-FOXO1 alterations influence clinical outcome in childhood and adolescence population with ARMS.

PROCEDURE

A population-based study was conducted between 2011 and 2016 in patients less than 17 years with a diagnosis of ARMS. Overall survival (OS) depending on fusion status with clinical factors was analyzed.

RESULTS

Out of 111 ARMS patients recorded in the French National Childhood Cancer Registry during the 2011-2016 period, 61% expressed PAX3-FOXO1, 15% expressed PAX7-FOXO1, 13% were FOXO1 fusion-positive without PAX specification, and 7% were PAX-FOXO1 negative (n = 4 missing data). Compared to patients with PAX7-FOXO1 positive ARMS, those with PAX3-FOXO1 positive tumor were significantly older (10-17 years: 57.4% vs. 29.4%), and had more often a metastatic disease (54.4% vs. 23.5%). Poorer 5-year OS for patients with PAX3-FOXO1 and PAX not specified FOXO1-positive tumor were observed (44.0% [32.0-55.4] and 35.7% [13.1-59.4], respectively). After adjustment for stage at diagnosis, patients with positive tumor for PAX3-FOXO1 were 3.6-fold more likely to die than those with positive tumor for PAX7-FOXO1.

CONCLUSION

At the population level, PAX3-FOXO1 was associated with a significant higher risk of death compared to PAX7-FOXO1-positive and PAX-FOXO1-negative tumors, and could explain poorer 5-year OS observed in adolescence population diagnosed with ARMS. A continuous risk score derived from the combination of clinical parameters with PAX3-FOXO1 fusion status represents a robust approach to improving current risk-adapted therapy for ARMS.

Long-term childhood cancer survival in Australia using period estimation

Estimates of childhood cancer survival are usually reported at 5 years after diagnosis only. Using cases prevalent between 2014 and 2018 from the population-based Australian Childhood Cancer Registry, we used the period method to calculate relative survival up to 20 years post diagnosis by cancer type. Twenty-year relative survival for all childhood cancers combined (n = 14,353) was 83.8% (95% confidence interval [CI] = 82.6%-85.0%). Survival decreased only slightly after 10 years for most childhood cancers, except for some types of brain and liver tumours. These contemporary estimates of long-term survival provide valuable information to assist childhood cancer patients and their families in planning for the future.

Use of period analysis to timely assess 5-year relative survival for breast cancer patients from Taizhou, Eastern China

OBJECTIVES

While timely assessment of long-term survival for patients with breast cancer is essential for evaluation on early detection and screening programs, those data are extremely scant in China. We aimed to derive most up-to-date survival estimates and to predict future survival using the cancer registry data from Taizhou city, Eastern China.

METHODS

Patients diagnosed with breast cancer during 2004-2018 from four cancer registries with high-quality data from Taizhou, Eastern China were included. Period analysis was used to calculate 5-year relative survival (RS) for the overall population and according to the stratification factors sex, age at diagnosis and geographic region. We further predict the upcoming 5-year RS during 2019-2023, using continuous data from three 5-year periods (2004-2008, 2009-2013 and 2014-2018) and a model-based period approach.

RESULTS

Overall 6159 patients diagnosed with breast cancer during 2004-2018 were enrolled. The 5-year RS for breast cancer in 2014-2018 reached 88.8%, while women were higher compared to men (90.5% versus 83.7%) and urban areas were higher compared to rural areas (91.9% versus 86.7%). Additionally, we found a clear gradient by age at diagnosis, ranging from 94.8% for age<45 years to 83.3% for age>74 years. Projected overall 5-year RS for the upcoming 2019-2023 could reach 91.5% (84.8% for men and 93.5% for women).

CONCLUSIONS

We provided, for first time in China, using period analysis, most up-to-date 5-year RS (88.8%) for patients with breast cancer from Taizhou, Eastern China. We also demonstrate the 5-year RS has improved greatly over last 15 years, which has important implications for timely evaluation of early detection and screening programs.

The French FRACTURE database: A way to improve knowledge on management of children with very rare tumors

INTRODUCTION

Very rare pediatric tumors (VRTs), defined by an annual incidence ≤2 per million inhabitants, represent a heterogeneous group of cancers. Due to their extremely low incidence, knowledge on these tumors is scant. Since 2012, the French Very Rare Tumors Committee (FRACTURE) database has recorded clinical data about VRTs in France. This study aims: (a) to describe the tumors registered in the FRACTURE database; and (b) to compare these data with those registered in the French National Registry of Childhood Cancer (RNCE).

METHODS

Data recorded in the FRACTURE database between January 1, 2012 and December 31, 2018 were analyzed. In addition, these data were compared with those of the RNCE database between 2012 and 2015 to evaluate the completeness of the documentation and understand any discrepancies.

RESULTS

A total of 477 patients with VRTs were registered in the FRACTURE database, representing 97 histological types. Of the 14 most common tumors registered in the RNCE (772 patients), only 19% were also registered in the FRACTURE database. Total 39% of children and adolescent VRTs registered in the RNCE and/or FRACTURE database (323 of a total of 828 patients) were not treated in or linked to a specialized pediatric oncology unit.

CONCLUSION

VRTs represent many different heterogenous entities, which nevertheless account for 10% of all pediatric cancers diagnosed each year. Sustainability in the collection of these rare tumor cases is therefore important, and a regular systematic collaboration between the FRACTURE database and the RNCE register helps to provide a more exhaustive picture of these VRTs and allow research completeness for some peculiar groups of patients.

[Pediatric Radiation Oncology in France: State of the Art]

Pediatric radiotherapy differs greatly from its practice in adults mainly because of the age (median age 6 years), which poses the problem of irradiation of healthy tissues in a growing organism, causing sequelae, difficult compliance and management of parents. These particularities require a dedicated education and specific organization that was set progressively concerning indications, quality control, exhaustive collection of native dosimetry, long-term follow-up and clinical and translational research, as well as accreditations to practice pediatric radiotherapy, in close collaboration with the French Society of Child and Adolescent Cancer and Leukemia (SFCE), under the aegis of the French Group of Pediatric Radiotherapy (GFRP). This organization is a pioneer in the development of pediatric radiotherapy quality controls, which are becoming the European standard and in the collection of native dosimetry integrated with the follow-up of possible late-effects, constituting the most important international database.

Childhood head and neck cancer in France: Incidence, survival and trends from 2000 to 2015

INTRODUCTION

Childhood head and neck cancers (HNC) are rare and represent a complex group of anatomical topographies. The aim of this study is to describe the distribution, the incidence and survival rates of children with malignant HNC in France.

METHODS

A population-based study was conducted between 2000 and 2015 in children less than 15 years with a diagnosis of HNC using the French National Registry of Childhood Cancers database (RNCE). Age-standardized incidence rates (ASR) and survival analysis were performed.

RESULTS

The 1623 included HNC represented 5.6% of all cancers included in the RNCE. The thyroid was the leading tumor site category (26.6%), followed by head and neck soft tissue location (15.4%) and the nasopharynx (10.8%). The most common cancers were thyroid gland carcinomas (26.1%), rhabdomyosarcomas (23.9%) and Burkitt Lymphomas (8.6%). Nasopharynx cancers and soft-tissue sarcomas were statistically more frequent in boys, while thyroid carcinomas were significantly more frequent in girls. The annual ASR was 8.6 new cancer cases per million children. For all HNC combined, the 5-year overall survival (OS) was 87.7% [95%CI: 85.9-89.2]. There was no statistically significant variation in 5-year OS between 2000-2007 and 2008-2015.

CONCLUSIONS

Epidemiological data on HNC distribution, incidence and survival contributes to better understand these tumors by quantifying their impact on the French population and assessing their burden. Regarding the exclusion of topographies and some histological origins performed by some authors, this report proposes new recommendations to study HNC in a pediatric population.