Global survival trends for brain tumors, by histology: Analysis of individual records for 67,776 children diagnosed in 61 countries during 2000-2014 (CONCORD-3)

Abstract

Introduction: Tumors of the central nervous system are among the leading causes of cancer-related death in children. Population-based cancer survival reflects the overall effectiveness of a health care system in managing cancer. Inequity in access to care world-wide may result in survival disparities.

Methods: We considered children (0-14 years) diagnosed with a brain tumor during 2000-2014, regardless of tumor behavior. Data underwent a rigorous, three-phase quality control as part of CONCORD-3. We implemented a revised version of the International Classification of Childhood Cancer (third edition) to control for under-registration of non-malignant astrocytic tumors. We estimated net survival using the unbiased nonparametric Pohar Perme estimator.

Results: The study included 67,776 children. We estimated survival for 12 histology groups, each based on relevant ICD-O-3 codes. Age-standardized 5-year net survival for low-grade astrocytoma ranged between 84% and 100% world-wide during 2000-2014. In most countries, 5-year survival was 90% or more during 2000-2004, 2005-2009, and 2010-2014. Global variation in survival for medulloblastoma was much wider, with age-standardized 5-year net survival between 47% and 86% for children diagnosed during 2010-2014.

Conclusions: To the best of our knowledge, this study provides the largest account to date of global trends in population-based survival for brain tumors in children, by histology. We devised an enhanced version of ICCC-3 to account for differences in cancer registration practices world-wide. Our findings may have public health implications, because low-grade glioma is 1 of the 6 index childhood cancers included by WHO in the Global Initiative for Childhood Cancer.

Keywords: brain tumor; cancer registries; childhood cancer; international comparisons; survival.

Fig. 1.

Age-standardized 5-year net survival (%) with 95% confidence interval, by country: children (0–14 years) diagnosed with low-grade astrocytoma or medulloblastoma during 2010–2014. *Countries with 100% coverage of the national population. §Survival estimates not age-standardized. Continents are identified by different colors. In each panel, countries are ranked from highest to lowest, based on survival during 2010–2014.

Fig. 2.

15-year trends in age-standardized 5-year net survival (%) for children (0–14 years) diagnosed with WHO grade I and II astrocytoma during 2000-2014, continent (or continental region), and country. Countries are only included if age-standardized survival estimates were available for patients diagnosed during 2000–2004, 2005–2009, and 2010–2014. Continents (or continental regions) are identified by different colors. In each panel, countries are ranked from highest to lowest, based on survival during 2000–2004. X-axis: period of diagnosis; Y-axis: age-standardized 5-year net survival (%). International Organization for Standardization abbreviations for country names: AUS, Australia; BLR, Belarus; CAN, Canada; FIN, Finland; FRA, France; ISR, Israel; ITA, Italy; NLD, Netherlands; POL, Poland; ESP, Spain; SWE, Sweden; CHE, Switzerland; GBR, UK; USA, USA.

Fig. 3.

15-year trends in age-standardized 5-year net survival (%) for children (0–14 years) diagnosed with medulloblastoma during 2000-2014, by continent (or continental region), and country. Countries are only included if age-standardized survival estimates were available for patients diagnosed during 2000–2004, 2005–2009, and 2010–2014. Continents (or continental regions) are identified by different colors. In each panel, countries are ranked from highest to lowest, based on survival during 2000–2004. X-axis: period of diagnosis; Y-axis: age-standardized 5-year net survival (%). International Organization for Standardization abbreviations for country names: AUS, Australia; FRA, France; ITA, Italy; NLD, Netherlands; KOR, South Korea; POL, Poland; TWN, Taiwan; GBR, UK; USA, USA.