Childhood Cancer Survival in Romania -a national pediatric registry perspective

Mihaela Bucurenci ^1* Li Zhang ² Breana Wayne ² Amr Soliman ³ Alexandra Elena Neaga ¹

• ¹ Romanian Society for Pediatric Oncology and Hematology, Bucuresti, Romania
• ² CEESP, New York, United States
• ³ Department of Community Health and Social Medicine, School of Medicine, City University of New York, New York, New York, United States

Introduction: Pediatric cancer survival is increasing over time in European countries. However, there are differences in survival between Eastern and Western European member countries. The available mortality data place Romania among the European countries with the highest child cancer mortality rates. Our study aims to investigate pediatric cancer survival and mortality outcomes in Romania, using national cancer registry data. The study included 4144 cancer patients aged 0-19 years, whose data were collected in the Romanian National Pediatric Oncology and Hematology Registry. These data comprise all new cases diagnosed in pediatric cancer facilities from January 1, 2010, to December 31, 2019. Survival probabilities were examined according to patient characteristics, such as tumour type, demography, geography and place of residence. The Chi-square test (Fisher Exact Test) was used to compare patients' personal and clinical characteristics by rural/urban designation. The Cox proportional hazards regression model was used to estimate the hazard ratios and 95% confidence intervals by rural/urban designation, economic development region, and selected cancer subtypes. The mean follow-up time was 6.09 ± 3.84 y. To calculate 5-year survival rates sample size was restricted to 3,308. A predictive model using multivariable logistic regression was used to assess the age group and rural-urban survival probabilities for major cancer subtypes. Results: The 5-year overall survival probability for the 0-14 and 15-19 age groups was 73% (95% CI: 71, 75) and 69% (65%, 72%). By smaller age groups, the survival rates were 75% (0-4 years), 73% (5-9 years) and 69% (10-14 years). Hodgkin lymphoma (92%), nephroblastoma (89 %), and lymphoid leukemias (80%) had the highest survival rates in the 0-14 years population. The worst survival was observed for CNS tumours (62%), rhabdomyosarcoma (62%), neuroblastoma (67%), and bone tumours (52%). Significantly more rural patients died from cancer (32.6% vs. 22.4%, p < 0.0001)than in urban areas.. Discussion/Conclusion: This is Romania's first pediatric cancer survival study based on well-validated national cancer registry data. Overall survival rates in Romania were lower than survival rates reported from the EU-15 countries. Rural patients had lower survival than urban patients. Future studies should investigate the association of clinical/socioeconomic characteristics and survival outcomes.