New Toronto Paediatric Cancer Stage principles provide expert consensus on the collection of paediatric cancer stages in population-based cancer registries

Adoption of these guidelines in registries will ease international comparative incidence and outcome studies.

TORONTO – Cancer stage is a core concept in oncology that is essential for the determination of cancer prognosis. Accurate stage data are crucial when comparing outcomes between groups over time. However, childhood cancers represent a particular data management challenge for registries as the criteria for staging paediatric cancers varies by diagnosis and has evolved over time. Most childhood malignant diseases are staged according to disease-specific staging systems that often differ between countries or clinical trial organizations.

Population-based cancer registries generate estimates of incidence and survival that are important for cancer surveillance, research, control strategies and policy. Although data on cancer stage allow meaningful assessments of changes in cancer incidence and outcomes, most population-based cancer registries do not record stage.  

Dr. Sumit Gupta, Staff Oncologist and Clinician Investigator at The Hospital for Sick Children (SickKids) and Dr. Lindsay Frazier, Associate Professor, Pediatric Oncology, Dana-Farber Cancer Institute, convened a panel of experts and advocacy stakeholders in Toronto to establish principles for paediatric cancer stage collection to be adopted by population-based cancer registries for the major childhood cancers, including adaptions for low-income countries. These guidelines were published online in the Lancet Oncology on March 30.

“Our aim is to get cancer registries the world over to start collecting all available paediatric cancer stage data in a way that's appropriate for paediatric populations and also considers adaption for low-income settings. Essentially, better data for kids with cancer worldwide,” says Dr. Gupta. “That data eventually will allow us to compare findings across jurisdictions, time, and more. We've formed an implementation group to make sure that our recommendations are taken up. Australia is already piloting them in their registry, the Union for International Cancer Control (UICC) major staging committee (TNM) has endorsed them and will include them in their next manual, online tools are being developed, and more pilots are being planned in Europe, Central America, and India.”

Because most paediatric cancers have specific staging systems, general adult classifications are not appropriate. The Toronto Paediatric Cancer Stage principles provide tiered, paediatric-specific staging systems to be adopted for paediatric cases by cancer registries in countries of all income levels. With a tiered approach, lower-tier staging systems are more basic and therefore should be feasible for resource-limited cancer registries to adopt. Higher-tier staging systems are more detailed and comprise more levels that can be collapsed down into those of the lower-tier systems, retaining comparability across registries.