Spectrum of Pediatric Malignancies An Observational Single Center Study from Western India

In India,   data is   collected through 33   population-based cancer registry and 29 hospital-based cancer registry which represents just 10% of population. This high-lights our knowledge gap regarding the true incidence of pediatric cancer in our country due to under reporting. Hence, leading to less diversion of resources for the management of pediatric cancer care and resulting in dismal outcomes in comparison to the western world. Moreover there is regional variation in reporting due to disparity in infrastructure and socioeconomic factors. our study is an attempt to strengthen the pediatric cancer epidemiological data and emphasize the demographic variations.

2. Material and Methods

It is a retrospective observational cohort study conduct- ed over a period of two years (April 2018 to March 2020) in the department of medical oncology at a government tertiary health care cancer facility of Rajasthan after obtaining permission from concerned authority. The data of total 140 cases were collected from hospital records. All children aged 0-18 years, diagnosed as a case of malignancy by means of peripheral blood smear s and bone marrow studies, cyto logical and his to pathological examination during this period, were included in the study.   His to logical diagnosis was confr medby our pathologist in all cases except for surgically inaccessible intra cranial tumors. The records of these patients were retrieved and analyzed,   focusing on the prevalence according to age, sex and types of tumors. For classification of pediatric malignancies in the present study, the International classification of childhood cancers   (ICC C), based on International classification of Diseases for oncology(ICD-o-3), was followed statistical analysis

The data were entered in an EXCEL Sheet and then analyzed. Descriptive statistics for continuous variable s and frequency distribution, with their percentages were calculated as required.

3. Results

The data were recorded for 140 pati cnts from age 0-18 years. patients were stratified in four groups i.e 0-4year; 5-9year;   ,10-1 4year and 15-18 year (Figure 1). Most of the patients (35.7 %) were placed in   15-18 year group (50/140), followed by 28.5% (40/140) patients in 5-9 year group. There were   18.5% and 17.1   %patients from age group 10-14years (26/140) and 0-4 years (24/140). The mean and median age is 10.3 years and 11 years respectively in the present study. sex wise distribution: Majority of cases,67.8%were male (95/140) in comparison to 32.1% (45/140) were female (Figure 2). The male to female ratio is 2.1 in the current study.

Figure   1. stratification of patients as perage groups.

      clinical Research

Figure 2. sex wise distribution clinical profle Among all pediatric cancers, the most common was leukemia with40% (56/140) of children afec ted (Figure 3/Table 1). The second most common was lymphoma 14.2% (20/140), followed by re tin oblast oma 11.4% (16/140) and malignant bone tumors 10% (14/140). Germ cell tumor, neuroblastoma and renal tumors each constitute five percent (6/140) cases.   soft tissue sarcoma and cNS neo plasm were 5%   (7/140) and 1.4% (2/140) respectively. Among others, there was a case of ad reno cortical tumor in a 17-year-old boy.

Figure3. Frequency of various cancers among study population

Table 1. Distribution of various cancers along the age groups

Among the subgroup of leukemia, acute lymph oblast ic leukemia was the most common with62.5% (35/56) cases. The most common age group affected was between 15 to 18 years with male predominance. Acute myeloid leukemia was 10.7% (15/140) of all the cases. There were 4 cases of chronic myeloid leukemia, 3 of them lie in age group 15 to 18. There was 10-year-old boy having myelodysplastic syndrome. Among the lymphoma subgroup, Hodgkin lymphoma was the commonest with 7.1% (10/140) cases. There was again male predominance with only single female case out of10. The most common age group affected was   15 to   18 years. There were 4.2% of non-Hodgkin lymphoma and4 case s ofun spec ifed lymphoma. E wings sarcoma (7.1%)was the commonest bone tumor followed by os teo sarcoma (2.1%). Most of our patients (80%) were started on treatment protocol as per the diagnosis (Figure 4).   seven percent refused for further treatment and 13% were referred to palliative or best supportive care.

Figure 4. Followup of the study cohort

4. Discussion

childhood cancers are often neglected as they represent a small proportion of all

cancers (0.7-4.4%). on the other hand when it occurs, it requires medical, psychological and societal concern. childhood cancer incidence appears to be increasing in India. As we contain the morbidity and mortality caused by infection and malnutrition, childhood cancer attain increasing priority in our country.

In the re port of International Incidence of childhood cancer volume-3 (II CR-3), age- standardized rate of child- hood cancer (0-19 year) incidence in India is 87.3 pm which is quite lower than countries like us (180 pm), canada (173.9 pm) or Europe (170-190pm).   This discrepancy can be explained by delay in diagnosis, under-reporting, poor health care access, centralization of resources, less than 10% population coverage by cancer registries.   'Missing' cases can be attributed to myriad of reasons ranging from societal to availability of health care service.

In this study, we retrospectively analyzed the data regarding demographics and spectrum of malignancies in 140 pediatric patients (0- 18 years) in a span of two years attending our tertiary health care facility.

AS Per II CR-3, ASRS Were   higher in children aged0-4 years (ASR 197.1 pm) and 15-19years (ASR 185.3 pm) than in those aged 5-9 years and 10-14 years. similar observation made in our study for the age group 15-18 years of age (35.7%; 50/140 cases), but not for 0-4 years. The possible explanation can be that this age group of0-4 years is obtaining treatment at the pediatric centre of our institute.

Incidence rates are slightly higher in boys than in girls(incidence sex ratio 1-14in the0-19 years age-group) and varied with age, region,and diagnostic group. In IICR- 3, the highest sex ratio incidence was reported from India (1.56) compared to 1.12-1.15 in high income countries(3). In our study, males were affected in 65.7% (95/140), while females were affected in 34.3% (45/140)cases. M: F ratio was 2.1:1. Similarly, Jussawalla et al (1.7), Das et al(2), Nandkumar et al (1.8), Chauhan et al (2.2) and Bryan et al (4) reported high sex ratios in their studies. Although according to Kusumakumary et al, male predominance is a salient feature of many childhood tumors . This high ratio cannot be explained solely biologically or genetically but a large number of sociocultural practices play in their part. Gender- based discrimination is seen in Southeast Asian countries which results into delayed healthcare seeking for all childhood illnesses including cancer.

Conflict of Interest

Acknowledgement