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Cancer Epidemiol. 2018 Jun;54:75-81. doi: 10.1016/j.canep.2018.03.012. Epub 2018 Apr 11.

Childhood nephroblastoma in Southern and Eastern Europe and the US: Incidence variations and temporal trends by human development index.

Author information

1
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Oncology Department, P & A Kyriakou Children's Hospital, Athens, Greece.
2
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece.
3
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece.
4
Pediatric Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, 'Agia Sofia' Children's Hospital, Athens, Greece.
5
Department of Pediatric Hematology-Oncology, 'Agia Sofia' Children's Hospital, Athens, Greece.
6
Department of Pediatric Hematology and Oncology, Hippokration Hospital, Thessaloniki, Greece.
7
Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece.
8
Pediatric Hematology-Oncology Department, "Mitera" Children's Hospital, Athens, Greece.
9
North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology, Porto, Portugal.
10
Registo Oncológico Regional do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, Portugal.
11
Cluj Regional Cancer Registry, The Oncology Institute 'Prof. Dr. Ion Chiricuţă', Cluj-Napoca, Romania.
12
Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus.
13
Malta National Cancer Registry, Department for Policy in Health-Health Information and Research, Pieta, Malta.
14
Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe, University Institute of Public Health, Ankara, Turkey.
15
National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine.
16
Croatian Institute of Public Health, Croatian National Cancer Registry, Zagreb, Croatia; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia.
17
Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznan, Poland.
18
Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
19
Belarusian Research Center for Paediatric Oncology, Haematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus.
20
Institute of Public Health of Serbia, Central Serbia Cancer Registry, Dr. Subotica 5, 11000, Belgrade, Serbia.
21
Department of Pathology, 'Aghia Sophia' Children's Hospital, Athens, Greece.
22
Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden. Electronic address: epetrid@med.uoa.gr.

Abstract

BACKGROUND:

Despite advances in the management of nephroblastoma (Wilms' tumor, WT), the etiology of the tumor remains obscure. We aimed to compare nephroblastoma incidence rates and time trends among children (0-14 years) in 12 Southern and Eastern European (SEE) countries and the Surveillance, Epidemiology, and End Results Program (SEER), USA, in relation to the human development index (HDI).

METHODS:

In total 1776 WT cases were recorded in 13 SEE collaborating registries (circa 1990-2016), whereas data on 2260 cases (1990-2012) were extracted from the SEER database. Age-standardized incidence rates (AIRs) were calculated and correlated with HDI, whereas temporal trends were evaluated using Poisson regression and Joinpoint analyses.

RESULTS:

The overall SEE AIR (9.2/106) was marginally higher than that of the SEER (8.3/106), whereas significant differences were noted among the 13 SEE registries which comprised mainly Caucasian populations. A statistically significant temporal increase in incidence was noted only in Belarus. Most cases (∼75%) were diagnosed before the fifth year of life, with rates steadily declining thereafter; median age at diagnosis was similar in SEE countries and SEER. A slight male preponderance in the first year of life (male:female = 1.1) was followed by a female preponderance in the older age groups (male:female = 0.7). Lastly, a statistically significant positive association between higher HDI and increasing nephroblastoma incidence was noted (regression coefficient: +3.25, 95%CI: +1.35, +5.15).

CONCLUSIONS:

Variations in incidence and time trends across the examined registries, changing male-to-female patterns with advancement in age, and positive associations with the HDI imply a plausible role for environmental and genetic factors in disease etiology, and these need to be explored further.

KEYWORDS:

Childhood; Gender differentials; Human development index; Incidence; Inequalities; Nephroblastoma; Time trends

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