Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines

Abstract

Population-based cancer registries generate estimates of incidence and survival that are essential for cancer surveillance, research, and control strategies. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, stage is not recorded by most population-based cancer registries. The main method of staging adult cancers is the TNM classification. The criteria for staging paediatric cancers, however, vary by diagnosis, have evolved over time, and sometimes vary by cooperative trial group. Consistency in the collection of staging data has therefore been challenging for population-based cancer registries. We assembled key experts and stakeholders (oncologists, cancer registrars, epidemiologists) and used a modified Delphi approach to establish principles for paediatric cancer stage collection. In this Review, we make recommendations on which staging systems should be adopted by population-based cancer registries for the major childhood cancers, including adaptations for low-income countries. Wide adoption of these guidelines in registries will ease international comparative incidence and outcome studies.

Baseline characteristics and outcomes of children with cancer in the English‐speaking Caribbean: A multinational retrospective cohort

“…Indeed, this highlights the utility of a more comprehensive comparison of stage at diagnosis across cancer types and settings. Recent guidelines for stage collection by childhood cancer registries have been published to facilitate such comparisons and have been found to be valid and feasible to implement . Population‐based stage comparisons across multiple regions, including the ESC, are currently being planned.…”

Stage at diagnosis for children with blood cancers in Australia: Application of the Toronto Paediatric Cancer Stage Guidelines in a population‐based national childhood cancer registry

“…Summary definitions for the stage categories by cancer type are provided in Table and full details are available elsewhere . On the basis that the level of involvement of the central nervous system (CNS) has been shown to have prognostic importance for ALL, the Toronto Guidelines recommend the classification used by the Children's Oncology Group (COG) as the best available measure of the extent of disease at diagnosis. The association between CNS involvement and survival for children with AML is less clear .…”

“…The association between CNS involvement and survival for children with AML is less clear . Hence, a simplified version of the COG staging system was endorsed . The Toronto Guidelines also sanction the well‐established Ann Arbor and St Jude‐Murphy staging systems for children with HL and NHL, respectively.…”

“…To address this gap, an international expert panel including pediatric oncologists, epidemiologists, cancer registrars, and advocacy stakeholders met in 2014 to review the major staging systems in current clinical use for 16 types of childhood cancer. A consensus was reached on the most appropriate system for use for each of these cancers in population registries . The recommendations were published as the Toronto Paediatric Cancer Staging Guidelines (referred to hereafter as “the Toronto Guidelines”) and have subsequently been endorsed by the Union for International Cancer Control (UICC) TNM Prognostic Factors project…”

Staging of acute leukemia based on central nervous system involvement alone: Is it appropriate?

“…We congratulate them for the commendable analysis of population‐wide distribution and survival outcome of pediatric lymphomas and leukemias in Australia. The Toronto Paediatric Cancer Stage Guidelines have been utilized by the authors to stage the leukemias and lymphomas . Staging defines the extent of cancer and facilitates decisions on treatment intensity and duration, response assessment, and prognostication.…”