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Keywords:

  • epidemiology;
  • childhood cancer;
  • adolescents;
  • survival;
  • trends

Abstract

  1. Top of page
  2. Abstract
  3. MATERIALS AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

BACKGROUND.

Survival trends provide a measure of improvement in detection and treatment over time. In the current study, updated childhood and adolescent cancer survival statistics are presented, overall and among demographic subgroups, including Hispanics, for whom to the authors' knowledge national rates have not been previously reported. These results extend those provided by the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program in their detail and interpretation.

METHODS.

Survival trends of primary cancers in children and adolescents (ages birth to 19 years) were evaluated using SEER 9 data. Five-year and 10-year relative survival rates across 5-year (1975-1979, 1985-1989, and 1995-1999) and 10-year (1975-1984 and 1985-1994) cohorts were compared via Z-tests. Annual percent change (APC) in survival was computed via weighted least-squares regression. Rates in Hispanic children and adolescents were compared with those in non-Hispanic whites and blacks (SEER 13, 1995-1999).

RESULTS.

Five-year survival rates increased significantly overall (1975-1979: 63% vs 1995-1999: 79%; P < .0001) and for nearly all histologic types examined; increases were greatest for ependymoma (+37%; P < .0001) and non-Hodgkin lymphoma (+34%; P < .0001). Hispanic children and adolescents had somewhat poorer 5-year rates than non-Hispanic whites overall (74% vs 81%; P < .0001) and for Ewing sarcoma, leukemia, central nervous system tumors, and melanoma. Ten-year rates also increased significantly overall (1975-1984: 61% vs 1985-1994: 72%; P < .0001) and for a majority of cancer types. The largest improvements were noted for acute lymphoblastic leukemia (+19%; P < .0001) and non-Hodgkin lymphoma (+19%; P < .0001).

CONCLUSIONS.

Observed trends reinforce the need for resources devoted to advancing treatment modalities, reducing disparities among racial/ethnic groups and adolescents, and providing long-term care of survivors. Cancer 2008. © 2008 American Cancer Society.

Cancers constitute the leading cause of disease-related mortality among children and adolescents in the US1; approximately 1545 children and adolescents aged birth through 14 years were predicted to die of a malignant neoplasm in 2007.2 The last comprehensive reports on childhood cancer survival3 and mortality trends4 included data through 1995. In the current study, we provide an updated analysis of childhood and adolescent cancer survival, including rates among Hispanics, for whom to our knowledge national rates have not been previously reported. These findings extend those furnished by the Surveillance, Epidemiology, and End Results (SEER) program by providing greater detail and interpretation of results.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. MATERIALS AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

SEER program data were analyzed to evaluate childhood and adolescent cancer survival trends.5 Since 1973, SEER has actively collected data on all cancer cases (excluding nonmelanoma skin cancers) in Connecticut, Hawaii, Iowa, New Mexico, Utah, Detroit, and San Francisco-Oakland. Seattle-Puget Sound was added in 1974 and Atlanta in 1975.6 These 9 registries represent approximately 9% of the US population.6 In 1992, SEER added Los Angeles, San Jose-Monterey, rural Georgia, and the Alaskan Native Tumor Registry, permitting the calculation of 5-year relative rates among Hispanic children and adolescents.6 This expanded SEER 13 dataset5 encompasses 14% of the population (whereas the full SEER 17 dataset covers 26% of the US population).6 With an estimated case ascertainment rate of 98%,7 SEER captures information regarding demographics, tumor site and morphology, stage at diagnosis, and treatment. SEER performs active ascertainment of vital status, with approximately 14% of pediatric and adolescent patients lost to follow-up.3

Fifteen common cancers and 8 subtypes were grouped according to the third edition of the International Classification of Diseases for Oncology (ICD-O-3)8 histology and topography codes (Table 1). We included first malignancies diagnosed during 3 5-year periods (1975-1979, 1985-1989, and 1995-1999) (Table 2) and 2 10-year periods (1975-1984 and 1985-1994) (Table 3) among those aged ≤19 years in the SEER 9 registries and first malignancies diagnosed during the period 1995 through 1999 among children and adolescents in the SEER 13 dataset. Approximately 95% of diagnoses were confirmed by histology.

Table 1. International Classification of Diseases for Oncology, Third Edition (ICD-O-3) Histology and Topography Codes
DiseaseCode
Any leukemia9800-9801, 9805, 9820, 9823, 9826-9827, 9831-9837, 9840, 9860-9861, 9863, 9866-9867, 9870-9876, 9891, 9895-9897, 9910, 9920, 9930-9931, 9940, 9945-9946, 9948
Acute lymphoblastic leukemia (ALL)9826, 9835-9837
Acute myeloid leukemia (AML)9840, 9861, 9866-9867, 9870-9874, 9891, 9895-9897, 9910, 9920, 9931
Other leukemias (lymphoid leukemias other than ALL/other specified and unspecified leukemias)9800-9801, 9805, 9820, 9823, 9827, 9831-9834, 9860, 9863, 9875-9876, 9930, 9940, 9945-9946, 9948
Hodgkin lymphoma9650-9655, 9659, 9661-9665, 9667
Non-Hodgkin lymphoma9590-9591, 9596, 9670-9671, 9673, 9675, 9678-9680, 9684, 9687, 9689-9691, 9695, 9698-9702, 9705, 9708-9709, 9714, 9716-9719, 9727-9729, 9731-9734, 9760-9762, 9764-9769, 9970
Any central nervous system (CNS) tumor8000-8005 (C70.0-C72.9, C75.1-C75.3), 8270-8281, 8300, 9350-9352, 9360-9362, 9380 (C70.0-C72.9, C75.1, C75.3), 9381-9384, 9390-9394, 9400-9413, 9420-9424, 9430, 9440-9442, 9444, 9450-9451, 9460, 9470-9474, 9480, 9492-9493, 9500 (C71.0-C71.9), 9501-9504 (C70.0-C72.9), 9505-9508, 9530-9539, 9582
Ependymoma9383, 9391-9394
Astrocytoma9380 (C72.3), 9384, 9400-9411, 9420-9424, 9440-9442
Primitive neuroectodermal tumors (PNET; medulloblastoma/PNET/ pineoblastoma/intracranial neuroblastoma)9362, 9470-9474, 9480, 9500 (C71.0-C71.9)
Other gliomas9380 (C70.0-C72.2, C72.4-C72.9, C75.1, C75.3), 9381-9382, 9430, 9444, 9450-9451, 9460
Other CNS tumors (choriod plexus tumors/medullopithelioma/atypical teratoid/rhabdoid tumors/other specified and unspecified CNS tumors)8000-8005 (C70.0-C72.9, C75.1-C75.3), 8270-8281, 8300, 9350-9352, 9360-9361, 9390, 9412-9413, 9492-9493, 9501-9504 (C70.0-C72.9), 9505-9508, 9530-9539, 9582
Extracranial neuroblastoma9490, 9500 (C00.0-C70.9, C72.0-C80.9)
Retinoblastoma9510-9514
Wilms tumor8959-8960
Hepatoblastoma8970
Osteosarcoma[9180-9187, 9191-9195, 9200] (C40.0-C41.9, C76.0-C76.8, C80.9)
Ewing sarcoma9260 (C40.0-C41.9, C76.0-C76.8, C80.9)
Rhabdomyosarcoma8900-8905, 8910, 8912, 8920, 8991
Non-rhabdomyosarcoma soft tissue sarcomas8587, 8710-8713, [8800-8805, 8810-8811, 8813-8815, 8821, 8823, 8830, 8834-8835] (C00.0-C39.9, C44.0-C76.8, C80.9), 8806, 8820, 8822, 8824-8827, 8831-8833, 8836, 8840-8842, 8850-8858, 8860-8862, 8870, 8880-8881, 8890-8898, 8921, 8963 (C00.0-C63.9, C65.9-C69.9, C73.9-C76.8, C80.9), 8982, 8990, 9040-9044, 9120-9125, 9130-9133, 9135-9136, 9140-9142, 9150, 9160-9161, 9170-9175, [9180, 9210, 9220, 9240] (C49.0-C49.9), 9231, 9251-9252, 9260 (C00.0-C39.9, C47.0-C75.9), 9364 (C00.0-C39.9, C47.0-C63.9, C65.9-C69.9, C73.9-C76.8, C80.9), 9365 (C00.0-C39.9, C47.0-C63.9, C65.9-C76.8, C80.9), 9373, 9491, 9540-9571, 9580-9581
Germ cell tumors[8000-8005, 8010-8041, 8050-8075, 8082, 8120-8122, 8130-8141, 8143, 8190-8201, 8210-8211, 8221-8241, 8244-8246, 8260-8263, 8290, 8310, 8313, 8320, 8323, 8380-8384, 8430, 8440, 8480-8490, 8504, 8510, 8550, 8560-8573, 9000, 9014-9015, 9073, 9090-9091] (C56.9, C62.0-C62.9), 8441-8444, 8450-8451, 8460-8473, 8590-8671, [9060-9065, 9070-9072, 9080-9085, 9100-9101] (C00.0-C55.9, C56.9-C72.9, C73.9-C76.8, C80.9), [9102-9105] (C00.0-C55.9, C57.0-C61.9, C63.0-C69.9, C73.9-C75.0, C75.4-C76.8, C80.9)
Thyroid carcinoma[8010-8041, 8050-8075, 8082, 8120-8122, 8130-8141, 8190, 8200-8201, 8211, 8230-8231, 8244-8246, 8260-8263, 8290, 8310, 8320, 8323, 8430, 8440, 8480-8481, 8510, 8560-8573] (C73.9), 8330-8337, 8340-8347, 8350
Malignant melanoma8720-8780, 8790
Table 2. 5-year Relative Survival Rates of Childhood and Adolescent Cancers in SEER 9 Registries for Diagnosis Years 1975-1979, 1985-1989, and 1995-1999 and Annual Percent Change (1975-1999)
Cancer1975-19791985-19891995-19991975-1999
No. (%)5-Year Survival Rate (%)*95% CINo. (%)5-Year Survival Rate (%)*95% CINo. (%)5-Year Survival Rate (%)*95% CIAPC (95% CI)
  • SEER indicates Surveillance, Epidemiology, and End Results program; 95% CI, 95% confidence interval; APC, annual percent change; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CNS, central nervous system; PNET, primitive neuroectodermal tumors.

  • *

    The 5-year relative survival rate was calculated via an actuarial method.

  • The frequencies and percentages in a column will not sum to those found in the “Total” row because only the most common cancers are reported.

  • Survival curve is significantly different from 1975-1979 curve (P < .05).

  • §

    Survival curve is significantly different from 1985-1989 curve (P < .05).

  • ‖, ¶

    The statistic could not be calculated.

  • Upper confidence level truncated at 100% and/or lower confidence level truncated at 0%.

Total4908 (100.0%)62.9(61.6-64.3)5196 (100.0%)72.8(71.6-74.0)5750 (100.0%)79.3,§(78.2-80.3)1.1 (1.0-1.2)
Leukemias1136 (23.1%)48.1(45.2-51.0)1284 (24.7%)66.2(63.6-68.8)1464 (25.5%)76.1,§(73.9-78.4)2.0 (1.6-2.4)
ALL784 (16.0%)56.8(53.3-60.3)979 (18.8%)74.9(72.2-77.6)1135 (19.7%)83.8,§(81.7-86.0)1.6 (1.2-2.0)
AML210 (4.3%)21.0(15.4-26.5)203 (3.9%)36.0(29.3-42.7)267 (4.6%)44.8(38.8-50.8)3.7 (2.6-4.9)
Other/unspecified leukemias142 (2.9%)40.0(31.8-48.1)102 (2.0%)41.7(32.1-51.4)62 (1.1%)70.9,§(59.5-82.4)
Hodgkin lymphoma564 (11.5%)87.0(84.2-89.9)466 (9.0%)90.0(87.3-92.8)440 (7.7%)96.0,§(94.1-97.9)0.5 (0.4-0.7)
Non-Hodgkin lymphoma319 (6.5%)46.9(41.4-52.4)328 (6.3%)68.6(63.5-73.7)371 (6.5%)81.0,§(76.9-85.0)2.1 (1.5-2.6)
CNS tumors801 (16.3%)58.6(55.2-62.1)962 (18.5%)64.8(61.8-67.9)1022 (17.8%)74.4,§(71.7-77.1)1.2 (0.9-1.5)
Ependymoma60 (1.2%)36.4(24.1-48.7)88 (1.7%)57.8(47.4-68.2)88 (1.5%)73.4,§(64.1-82.8)3.1 (2.0-4.1)
Astrocytoma390 (7.9%)68.8(64.2-73.5)495 (9.5%)72.6(68.7-76.6)480 (8.3%)85.4,§(82.2-88.6)1.2 (0.9-1.5)
PNET152 (3.1%)47.5(39.5-55.5)190 (3.7%)54.5(47.3-61.6)256 (4.5%)64.9,§(59.0-70.8)1.2 (0.4-2.1)
Other gliomas168 (3.4%)53.9(46.3-61.5)155 (3.0%)58.7(50.9-66.5)174 (3.0%)59.9(52.6-67.2)0.1 (-1.0-1.1)
Other/unspecified CNS tumors31 (0.6%)54.1(36.2-72.0)34 (0.7%)54.8(37.7-71.8)24 (0.4%)64.6(44.6-84.6)
Neuroblastoma242 (4.9%)54.3(48.0-60.7)270 (5.2%)58.2(52.2-64.2)297 (5.2%)67.0,§(61.5-72.5)1.4 (0.7-2.2)
Retinoblastoma88 (1.8%)92.5(86.8-98.2)106 (2.0%)92.0(86.5-97.4)111 (1.9%)96.5(92.8-100)
Wilms tumor185 (3.8%)75.0(68.7-81.3)207 (4.0%)92.0(88.3-95.8)223 (3.9%)91.5(87.8-95.2)0.5 (0.1-0.9)
Hepatoblastoma25 (0.5%)44.3(24.7-64.0)38 (0.7%)60.7(45.0-76.4)59 (1.0%)60.3(47.5-73.0)
Osteosarcoma137 (2.8%)45.4(37.0-53.8)155 (3.0%)62.8(55.2-70.5)174 (3.0%)65.1(58.0-72.2)1.5 (0.6-2.5)
Ewing sarcoma94 (1.9%)42.4(32.4-52.5)94 (1.8%)57.3(47.2-67.4)84 (1.5%)66.8(56.7-76.9)3.0 (1.6-4.4)
Rhabdomyosarcoma140 (2.9%)49.2(40.8-57.5)157 (3.0%)60.0(52.3-67.7)167 (2.9%)62.8(55.4-70.1)0.7 (-0.3-1.7)
Nonrhabdomyosarcoma soft tissue sarcomas215 (4.4%)76.1(70.4-81.9)206 (4.0%)78.6(72.9-84.3)260 (4.5%)78.7(73.7-83.8)0.1 (-0.3-0.5)
Germ cell tumors319 (6.5%)71.8(66.8-76.7)332 (6.4%)86.2(82.4-89.9)378 (6.6%)92.0,§(89.2-94.9)0.9 (0.6-1.3)
Thyroid carcinoma174 (3.5%)99.5(98.3-100)169 (3.3%)98.5(96.5-100)203 (3.5%)98.2(96.3-100)
Melanoma155 (3.2%)82.8(76.8-88.8)162 (3.1%)90.3(85.6-95.0)173 (3.0%)93.3(89.4-97.1)
Table 3. 10-Year Relative Survival Rates of Childhood and Adolescent Cancers in SEER 9 Registries for Diagnosis Years 1975-1984 and 1985-1994
Cancer1975-19841985-1994
No. (%)10-Year Survival Rate (%)*95% CINo. (%)10-Year Survival Rate (%)*95% CI
  • SEER indicates Surveillance, Epidemiology, and End Results program; 95% CI, 95% confidence interval; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CNS, central nervous system; PNET, primitive neuroectodermal tumors.

  • *

    The 10-year relative survival rate was calculated via an actuarial method.

  • The frequencies and percentages in a column will not sum to those found in the “Total” row because only the most common cancers are reported.

  • Survival curve is significantly different from 1975-1984 curve (P<.05).

  • §

    Upper confidence level truncated at 100% and/or lower confidence level truncated at 0%.

Total9817 (100.0%)61.1(60.2-62.1)10,662 (100.0%)71.8(70.9-72.7)
Leukemias2329 (23.7%)45.7(43.6-47.7)2616 (24.5%)64.5(62.7-66.4)
ALL1671 (17.0%)54.2(51.8-56.6)1953 (18.3%)73.1(71.1-75.1)
AML404 (4.1%)19.6(15.7-23.5)456 (4.3%)37.3(32.9-41.8)
Other/unspecified leukemias254 (2.6%)30.5(24.7-36.2)207 (1.9%)43.4(36.6-50.3)
Hodgkin lymphoma1051 (10.7%)81.1(78.6-83.5)896 (8.4%)89.0(86.8-91.1)
Non-Hodgkin lymphoma649 (6.6%)52.8(48.9-56.7)674 (6.3%)71.4(67.9-74.9)
CNS tumors1553 (15.8%)54.7(52.2-57.2)2006 (18.8%)63.4(61.2-65.5)
Ependymoma113 (1.2%)32.5(23.7-41.2)162 (1.5%)49.1(41.3-56.9)
Astrocytoma781 (8.0%)64.8(61.4-68.2)1032 (9.7%)74.3(71.6-77.1)
PNET302 (3.1%)46.3(40.6-51.9)407 (3.8%)51.6(46.7-56.5)
Other gliomas296 (3.0%)47.0(41.3-52.8)345 (3.2%)54.4(49.1-59.7)
Other/unspecified CNS tumors61 (0.6%)45.6(32.9-58.3)60 (0.6%)46.1(33.3-58.8)
Neuroblastoma500 (5.1%)51.7(47.2-56.1)570 (5.3%)62.8(58.8-66.9)
Retinoblastoma184 (1.9%)91.9(87.7-96.1)243 (2.3%)92.9(89.5-96.4)
Wilms tumor400 (4.1%)79.9(75.9-83.9)440 (4.1%)91.2(88.5-93.9)
Hepatoblastoma56 (0.6%)48.3(35.1-61.6)85 (0.8%)61.3(50.9-71.8)
Osteosarcoma292 (3.0%)45.1(39.3-50.9)313 (2.9%)59.3(53.8-64.9)
Ewing sarcoma214 (2.2%)39.4(32.8-46.1)198 (1.9%)51.2(44.1-58.2)
Rhabdomyosarcoma276 (2.8%)53.8(47.8-59.7)317 (3.0%)64.5(59.2-69.8)
Nonrhabdomyosarcoma soft tissue sarcomas434 (4.4%)73.7(69.4-77.9)401 (3.8%)73.0(68.6-77.5)
Germ cell tumors671 (6.8%)75.9(72.6-79.3)696 (6.5%)85.2(82.5-88.0)
Thyroid carcinoma344 (3.5%)98.3(96.7-99.9)328 (3.1%)98.6(97.2-100§)
Melanoma283 (2.9%)81.6(76.9-86.3)330 (3.1%)90.0(86.6-93.4)

Statistical Analysis

Five-year and 10-year relative survival rates were calculated via the life tables method in SEER*STAT.9 Ten-year survival has not been traditionally reported, but may be a more relevant measure of survival in children and adolescents, given advancements in survival duration and greater potential for years of life lost. Relative rates, presented as percentages, are ratios of observed-to-expected survival. Observed rates included all individuals diagnosed with a malignancy actively followed through 2004; expected rates were based on National Center for Health Statistics data. Expected rates account for differing distributions of age, sex, race, and year of diagnosis. Adjustments were made for relative rates >1.0, increasing rates, and heterogeneity in withdrawal (exact method).

Standard errors9 and 95% confidence intervals (95% CIs) were calculated and Z-tests used to compare the relative survival functions across the 3 diagnostic cohorts in the SEER 9 populations.10 Similarly, 5-year survival functions among Hispanic children/adolescents were compared with those among non-Hispanic whites and blacks (data not shown) in the SEER 13 registries (Table 4).10 Survival differences corresponding to a P value of ≤0.05 were considered statistically significant. To examine 5-year trends across the 25-year period, average annual percent change (APC) and the corresponding 95% CI were computed via weighted least-squares regression using Joinpoint software,11 in which the independent variable was calendar year and the dependent variable was the natural logarithm of the relative rate. Rates across strata of sex (male vs female), race (white vs black), and age group (<1 year, 1-4 years, 5-9 years, 10-14 years, and 15-19 years) were also evaluated (Tables 5 and 6). Other races (American Indian/Alaskan Native, Asian/Pacific Islander) were not included because of small numbers. The study was approved by the University of Minnesota Institutional Review Board.

Table 4. 5-Year Relative Survival Rates of Cancer Among Hispanic Children and Adolescents in SEER 13 Registries in 1995-1999
CancerNo. (%)5-year Survival Rate (%)*95% CI
  • SEER indicates Surveillance, Epidemiology, and End Results program; 95% CI, 95% confidence interval; ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CNS, central nervous system; PNET, primitive neuroectodermal tumors.

  • *

    The 5-year relative survival rate was calculated via an actuarial method.

  • The frequencies and percentages in a column will not sum to those found in the “Total” row because only the most common cancers are reported.

  • Survival curve is significantly different from curve in non-Hispanic whites (P < .05). No significant differences were observed compared with rates in non-Hispanic black children and adolescents.

  • §

    Upper confidence level truncated at 100%.

Total1999 (100.0%)73.9(72.0-75.9)
Leukemias736 (36.8%)70.5(67.2-73.8)
ALL597 (29.9%)77.2(73.8-80.6)
AML110 (5.5%)38.2(29.0-47.3)
Other/unspecified leukemias29 (1.5%)55.3(37.1-73.4)
Hodgkin lymphoma127 (6.4%)94.6(90.5-98.6)
Non-Hodgkin lymphoma104 (5.2%)79.6(71.8-87.5)
CNS tumors291 (14.6%)65.9(60.4-71.5)
Ependymoma19 (1.0%)71.4(50.0-92.8)
Astrocytoma122 (6.1%)75.4(67.7-83.1)
PNET87 (4.4%)67.7(57.8-77.6)
Other gliomas49 (2.5%)42.9(29.0-56.8)
Other/unspecified CNS tumors14 (0.7%)46.6(19.4-73.8)
Neuroblastoma76 (3.8%)69.0(58.3-79.6)
Retinoblastoma48 (2.4%)98.0(93.9-100§)
Wilms tumor74 (3.7%)90.4(83.6-97.3)
Hepatoblastoma18 (0.9%)61.3(38.7-83.9)
Osteosarcoma51 (2.6%)57.0(43.3-70.6)
Ewing sarcoma20 (1.0%)27.0(6.9-47.1)
Rhabdomyosarcoma44 (2.2%)51.3(36.3-66.2)
Nonrhabdomyosarcoma soft tissue sarcomas77 (3.9%)72.7(62.6-82.7)
Germ cell tumors160 (8.0%)88.8(83.8-93.9)
Thyroid carcinoma59 (3.0%)98.3(95.0-100§)
Melanoma13 (0.7%)76.9§(54.0-99.9)
Table 5. 5-Year Relative Survival Rates of Childhood and Adolescent Cancers in SEER 9 Registries by Subgroup for Diagnosis Years 1975-1979, 1985-1989, and 1995-1999 and Annual Percent Change (APC, 1975-1999)
Cancer1975-19791985-19891995-19991975-1999
No. (%)5-Year Survival Rate (%)*95% CINo. (%)5-Year Survival Rate (%)*95% CINo. (%)5-Year Survival Rate (%)*95% CIAPC (95% CI)
  • *

    5-year relative survival rate calculated via actuarial method.

  • 95% CI: 95% confidence interval.

  • The frequencies and percentages in a column will not sum to those found in the “Total” row, as only the most common cancers are reported.

  • §

    The statistic could not be calculated.

  • Survival curve is significantly different from 1975-1979 curve (p<0.05).

  • Survival curve is significantly different from 1985-1989 curve (p<0.05).

  • **

    Upper confidence level truncated at 100% and/or lower confidence level truncated at 0%.

Male
Total2561 (100.0%)57.7(55.8-59.7)2803 (100.0%)69.8(68.0-71.5)3119 (100.0%)77.5(76.0-79.0)1.4 (1.1-1.6)
Leukemias654 (25.5%)44.3(40.5-48.1)738 (26.3%)63.1(59.6-66.6)837 (26.8%)75.1(72.1-78.0)2.2 (1.6-2.7)
 Acute lymphoblastic leukemia (ALL)447 (17.5%)51.8(47.2-56.5)568 (20.3%)73.1(69.4-76.8)658 (21.1%)82.6(79.6-85.5)1.8 (1.3-2.3)
 Acute myeloid leukemia (AML)117 (4.6%)21.4(13.8-28.9)102 (3.6%)23.2(14.9-31.5)144 (4.6%)43.1(35.0-51.2)4.2 (2.6-5.9)
 Other/unspecified leukemias90 (3.5%)36.3(26.2-46.3)68 (2.4%)37.5(25.8-49.1)35 (1.1%)65.7(49.7-81.6)§
Hodgkin lymphoma284 (11.1%)85.7(81.6-89.9)243 (8.7%)89.3(85.3-93.3)214 (6.9%)96.2(93.5-98.9)§
Non-Hodgkin lymphom220 (8.6%)42.5(35.9-49.0)216 (7.7%)66.8(60.4-73.1)265 (8.5%)80.9(76.1-85.7)2.1 (1.2-2.9)
Central nervous system (CNS) tumors435 (17.0%)57.0(52.3-61.7)530 (18.9%)64.9(60.8-69.0)582 (18.7%)72.7(69.0-76.3)1.3 (0.9-1.7)
 Ependymoma38 (1.5%)34.4(19.2-49.5)51 (1.8%)57.1(43.4-70.7)52 (1.7%)74.7(62.8-86.7)3.3 (1.9-4.6)
 Astrocytoma212 (8.3%)68.6(62.3-74.9)258 (9.2%)72.2(66.7-77.7)259 (8.3%)82.6(77.9-87.3)1.0 (0.6-1.4)
 Primitive neuroectodermal tumors (PNET)88 (3.4%)39.9(29.7-50.2)114 (4.1%)58.3(49.2-67.5)152 (4.9%)65.3(57.7-73.0)1.6 (0.4-2.9)
 Other gliomas82 (3.2%)60.7(50.0-71.4)90 (3.2%)62.2(52.1-72.3)103 (3.3%)59.3(49.8-68.9)0.2 (-0.8-1.2)
 Other/unspecified CNS tumors15 (0.6%)29.5(5.3-53.6)17 (0.6%)35.4(12.6-58.3)16 (0.5%)60.9(36.1-85.7)§
Neuroblastoma (extracranial)122 (4.8%)51.7(42.7-60.6)143 (5.1%)59.0(50.8-67.2)148 (4.7%)67.7(60.0-75.4)1.7 (0.8-2.7)
Retinoblastoma41 (1.6%)95.6(88.8-100**)51 (1.8%)92.6(85.0-100**)40 (1.3%)97.7(92.4-100**)§
Wilms tumor83 (3.2%)72.7(63.0-82.4)95 (3.4%)88.7(82.3-95.2)106 (3.4%)90.6(85.0-96.3)§
Hepatoblastoma14 (0.5%)57.7(31.5-83.9)19 (0.7%)52.0(29.0-75.1)34 (1.1%)57.9(41.0-74.8)§
Osteosarcoma63 (2.5%)38.2(26.2-50.3)93 (3.3%)59.4(49.4-69.5)117 (3.8%)66.0(57.4-74.7)2.0 (0.8-3.2)
Ewing sarcoma59 (2.3%)35.7(23.4-48.0)51 (1.8%)48.9(35.0-62.7)53 (1.7%)68.1(55.5-80.7)§
Rhabdomyosarcoma83 (3.2%)45.8(35.0-56.6)105 (3.7%)64.0(54.7-73.2)102 (3.3%)62.6(53.1-72.0)0.7 (−0.5-2.0)
Non-rhabdomyosarcoma soft tissue sarcomas113 (4.4%)72.9(64.6-81.2)104 (3.7%)78.0(69.9-86.2)125 (4.0%)76.8(69.2-84.3)0.2 (−0.4-0.8)
Germ cell tumors168 (6.6%)66.5(59.2-73.7)186 (6.6%)82.7(77.2-88.2)235 (7.5%)91.3(87.6-95.0)1.3 (0.9-1.6)
Thyroid carcinoma31 (1.2%)100.0(100.0-100.0)28 (1.0%)93.4(83.8-100**)33 (1.1%)97.1(91.2-100**)§
Malignant melanoma58 (2.3%)77.8(66.8-88.7)64 (2.3%)88.0(79.8-96.1)67 (2.1%)94.3(88.4-100**)§
Female
Total2347 (100.0%)68.6(66.7-70.5)2393 (100.0%)76.3(74.6-78.0)2631 (100.0%)81.4(79.9-82.9)0.9 (0.7-1.0)
Leukemias482 (20.5%)53.3(48.8-57.8)546 (22.8%)70.3(66.5-74.2)627 (23.8%)77.6(74.3-80.9)1.7 (1.2-2.2)
 ALL337 (14.4%)63.4(58.3-68.6)411 (17.2%)77.4(73.3-81.4)477 (18.1%)85.6(82.4-88.8)1.3 (0.8-1.8)
 AML93 (4.0%)20.5(12.3-28.7)101 (4.2%)48.6(38.8-58.4)123 (4.7%)46.8(37.8-55.7)3.1 (1.2-5.1)
 Other/unspecified leukemias52 (2.2%)46.3(32.7-59.9)34 (1.4%)50.1(33.3-67.0)27 (1.0%)77.9(62.1-93.6)§
Hodgkin lymphoma280 (11.9%)88.4(84.6-92.2)223 (9.3%)90.7(86.9-94.6)226 (8.6%)95.7(93.0-98.4)0.5 (0.4-0.7)
Non-Hodgkin lymphoma99 (4.2%)57.0(47.2-66.9)112 (4.7%)72.2(63.8-80.5)106 (4.0%)81.1(73.6-88.6)1.9 (1.2-2.6)
CNS tumors366 (15.6%)60.6(55.5-65.6)432 (18.1%)64.7(60.2-69.3)440 (16.7%)76.7(72.7-80.7)1.1 (0.5-1.7)
 Ependymoma22 (0.9%)40.5(19.7-61.3)37 (1.5%)58.9(42.8-75.0)36 (1.4%)71.6(56.6-86.5)§
 Astrocytoma178 (7.6%)69.0(62.2-75.9)237 (9.9%)73.1(67.4-78.8)221 (8.4%)88.7(84.5-92.9)1.5 (0.9-2.0)
 PNET64 (2.7%)57.9(45.8-70.0)76 (3.2%)48.8(37.5-60.0)104 (4.0%)64.3(55.1-73.6)-0.3 (−1.5-0.9)
 Other gliomas86 (3.7%)47.4(36.8-58.0)65 (2.7%)53.9(41.8-66.0)71 (2.7%)60.6(49.2-72.0)-0.4 (−1.8-1.1)
 Other/unspecified CNS tumors16 (0.7%)75.2(53.9-96.5)17 (0.7%)75.2(53.9-96.5)8 (0.3%)73.0(40.6-100**)§
Neuroblastoma120 (5.1%)57.0(48.1-65.9)127 (5.3%)57.3(48.6-66.0)149 (5.7%)66.3(58.5-74.2)1.3 (0.2-2.4)
Retinoblastoma47 (2.0%)89.8(80.9-98.7)55 (2.3%)91.3(83.6-99.0)71 (2.7%)95.9(90.9-100**)§
Wilms tumor102 (4.3%)76.8(68.5-85.1)112 (4.7%)94.8(90.6-99.0)117 (4.4%)92.3(87.4-97.3)§
Hepatoblastoma11 (0.5%)27.4(0.9-53.9)19 (0.8%)68.8(47.7-89.8)25 (1.0%)63.9(44.9-82.9)§
Osteosarcoma74 (3.2%)51.5(40.0-62.9)62 (2.6%)67.8(56.2-79.5)57 (2.2%)63.2(50.7-75.8)1.1 (0.0-2.3)
Ewing sarcoma35 (1.5%)54.0(37.3-70.6)43 (1.8%)67.3(53.2-81.4)31 (1.2%)64.6(47.7-81.4)§
Rhabdomyosarcoma57 (2.4%)54.1(41.1-67.2)52 (2.2%)52.0(38.4-65.6)65 (2.5%)63.0(51.2-74.8)0.5 (−0.8-1.8)
Non-rhabdomyosarcoma soft tissue sarcomas102 (4.3%)79.6(71.7-87.5)102 (4.3%)79.2(71.2-87.2)135 (5.1%)80.5(73.8-87.3)0.0 (−0.4-0.5)
Germ cell tumors151 (6.4%)77.6(70.9-84.3)146 (6.1%)90.5(85.6-95.3)143 (5.4%)93.2(89.0-97.4)0.5 (0.1-0.9)
Thyroid carcinoma143 (6.1%)99.3(98.0-100**)141 (5.9%)99.5(98.1-100**)170 (6.5%)98.4(96.4-100**)§
Melanoma97 (4.1%)85.7(78.7-92.8)98 (4.1%)91.8(86.3-97.3)106 (4.0%)92.6(87.6-97.7)§
White
Total4194 (100.0%)63.0(61.6-64.5)4242 (100.0%)74.4(73.0-75.7)4530 (100.0%)80.5(79.3-81.6)1.1 (1.0-1.3)
Leukemias980 (23.4%)49.0(45.8-52.1)1028 (24.2%)68.2(65.3-71.0)1150 (25.4%)77.6(75.2-80.0)2.0 (1.5-2.4)
 ALL683 (16.3%)58.1(54.3-61.8)796 (18.8%)77.2(74.2-80.1)913 (20.2%)84.9(82.5-87.2)1.5 (1.2-1.9)
 AML170 (4.1%)19.4(13.4-25.4)152 (3.6%)35.9(28.3-43.6)191 (4.2%)43.8(36.7-50.8)4.0 (2.6-5.5)
 Other/unspecified leukemias127 (3.0%)39.1(30.6-47.7)80 (1.9%)39.3(28.5-50.2)46 (1.0%)74.1(61.3-86.8)§
Hodgkin lymphoma507 (12.1%)87.1(84.2-90.1)417 (9.8%)90.7(87.9-93.6)384 (8.5%)96.6(94.7-98.5)§
Non-Hodgkin lymphoma286 (6.8%)46.0(40.2-51.8)276 (6.5%)68.4(62.9-74.0)284 (6.3%)81.8(77.3-86.4)2.2 (1.6-2.9)
CNS tumors691 (16.5%)60.0(56.3-63.7)791 (18.6%)67.2(63.9-70.5)806 (17.8%)76.7(73.7-79.6)1.2 (0.8-1.6)
 Ependymom53 (1.3%)37.4(24.2-50.6)68 (1.6%)58.6(46.8-70.4)76 (1.7%)72.2(62.0-82.3)2.4 (1.2-3.6)
 Astrocytoma353 (8.4%)69.8(65.0-74.6)410 (9.7%)75.2(71.0-79.5)379 (8.4%)87.3(83.9-90.7)1.2 (0.8-1.5)
 PNET122 (2.9%)47.7(38.8-56.6)159 (3.7%)55.0(47.2-62.8)201 (4.4%)67.4(60.9-73.9)1.4 (0.5-2.3)
 Other gliomas137 (3.3%)55.9(47.4-64.3)126 (3.0%)63.6(55.2-72.1)131 (2.9%)64.2(56.0-72.4)0.0 (−1.0-1.1)
 Other/unspecified CNS tumors26 (0.6%)53.0(33.4-72.6)28 (0.7%)55.8(37.0-74.6)19 (0.4%)65.3(42.7-88.0)§
Neuroblastoma208 (5.0%)52.5(45.7-59.4)217 (5.1%)57.7(51.1-64.4)231 (5.1%)67.0(60.7-73.2)1.5 (0.7-2.3)
Retinoblastoma62 (1.5%)90.8(83.3-98.2)82 (1.9%)93.0(87.3-98.8)77 (1.7%)97.6(93.9-100**)§
Wilms tumor154 (3.7%)75.7(68.8-82.5)168 (4.0%)91.9(87.7-96.1)167 (3.7%)91.6(87.3-95.9)0.6 (0.2-1.0)
Hepatoblastoma18 (0.4%)44.8(21.6-68.0)28 (0.7%)61.0(42.8-79.2)37 (0.8%)54.2(38.1-70.3)§
Osteosarcoma100 (2.4%)43.2(33.4-52.9)115 (2.7%)63.7(54.8-72.5)131 (2.9%)67.3(59.2-75.4)1.7 (0.7-2.7)
Ewing sarcoma87 (2.1%)42.4(31.9-52.9)85 (2.0%)55.1(44.4-65.8)80 (1.8%)65.1(54.6-75.6)2.9 (1.5-4.3)
Rhabdomyosarcoma121 (2.9%)48.6(39.7-57.6)128 (3.0%)61.9(53.5-70.4)121 (2.7%)58.4(49.6-67.3)0.6 (−0.5-1.7)
Non-rhabdomyosarcoma soft tissue sarcomas168 (4.0%)75.9(69.4-82.4)154 (3.6%)81.1(74.8-87.4)201 (4.4%)80.9(75.4-86.4)0.3 (−0.1-0.8)
Germ cell tumors274 (6.5%)70.7(65.3-76.1)261 (6.2%)87.2(83.0-91.3)285 (6.3%)93.3(90.2-96.3)0.9 (0.5-1.3)
Thyroid carcinoma149 (3.6%)99.4(98.1-100**)143 (3.4%)98.2(95.8-100**)171 (3.8%)97.9(95.6-100**)§
Melanoma147 (3.5%)81.9(75.6-88.2)153 (3.6%)90.4(85.7-95.2)161 (3.6%)93.4(89.4-97.3)§
Black
Total449 (100.0%)60.1(55.6-64.7)529 (100.0%)62.5(58.3-66.6)601 (100.0%)73.4(69.8-77.0)1.1 (0.8-1.5)
Leukemias78 (17.4%)37.3(26.5-48.1)105 (19.8%)53.4(43.8-63.0)131 (21.8%)68.7(60.7-76.7)3.1 (2.0-4.3)
 ALL43 (9.6%)42.0(27.2-56.8)72 (13.6%)57.0(45.4-68.5)95 (15.8%)74.6(65.7-83.4)2.4 (1.2-3.7)
 AML24 (5.3%)29.3(11.0-47.5)21 (4.0%)38.2(17.3-59.1)31 (5.2%)51.8(34.2-69.5)§
 Other/unspecified leukemias11 (2.4%)36.5(7.9-65.0)12 (2.3%)58.4(30.4-86.4)5 (0.8%)60.3(16.9-100**)§
Hodgkin lymphoma41 (9.1%)80.9(68.7-93.1)37 (7.0%)78.8(65.5-92.2)41 (6.8%)90.6(81.4-99.7)§
Non-Hodgkin lymphoma22 (4.9%)45.6(24.7-66.5)29 (5.5%)76.2(60.6-91.9)41 (6.8%)78.2(65.5-90.9)§
CNS tumors79 (17.6%)50.8(39.7-61.9)117 (22.1%)51.3(42.1-60.4)116 (19.3%)64.3(55.5-73.2)1.1 (0.0-2.1)
 Ependymoma5 (1.1%)20.1(0**-55.3)14 (2.6%)43.1(17.0-69.1)6 (1.0%)80.1(45.0-100**)§
 Astrocytoma26 (5.8%)65.5(47.2-83.9)62 (11.7%)56.6(44.2-69.0)53 (8.8%)75.3(63.5-87.1)§
 PNET21 (4.7%)52.6(31.1-74.0)19 (3.6%)52.8(30.2-75.3)27 (4.5%)63.2(44.9-81.4)§
 Other gliomas24 (5.3%)41.7(22.0-61.5)18 (3.4%)36.6(13.6-59.6)27 (4.5%)44.6(25.7-63.4)§
 Other/unspecified CNS tumors3 (0.7%)33.4(0**-87.1)4 (0.8%)50.3(0.9-99.6)3 (0.5%)33.7(0**-87.7)§
Neuroblastoma25 (5.6%)60.5(41.1-80.0)32 (6.0%)56.6(39.2-74.0)42 (7.0%)68.1(53.5-82.8)§
Retinoblastoma15 (3.3%)93.9(81.2-100**)17 (3.2%)82.9(63.7-100**)15 (2.5%)100.0(100.0-100.0)§
Wilms tumor25 (5.6%)68.5(50.0-86.9)27 (5.1%)96.5(89.4-100**)39 (6.5%)95.0(88.1-100**)§
Hepatoblastoma4 (0.9%)50.3(0.9-99.8)5 (0.9%)20.2(0**- 55.8)7 (1.2%)51.7(11.5-92.0)§
Osteosarcoma19 (4.2%)58.0(35.7-80.3)20 (3.8%)55.4(33.4-77.3)23 (3.8%)43.6(23.3-63.9)§
Ewing sarcoma3 (0.7%)66.7(13.2-100**)1 (0.2%)100.0(100.0-100.0)0 (0.0%)§ §
Rhabdomyosarcoma13 (2.9%)46.4(19.2-73.7)22 (4.2%)45.6(24.7-66.4)30 (5.0%)70.2(53.7-86.6)§
Non-rhabdomyosarcoma soft tissue sarcomas30 (6.7%)66.9(50.0-83.9)33 (6.2%)61.1(44.3-77.9)33 (5.5%)73.1(57.8-88.4)§
Germ cell tumors28 (6.2%)82.4(68.1-96.6)36 (6.8%)89.2(78.8-99.5)33 (5.5%)88.1(76.5-99.7)§
Thyroid carcinoma10 (2.2%)100.0(100.0-100.0)9 (1.7%)100.0(100.0-100.0)10 (1.7%)100.0(100.0-100.0)§
Melanoma1 (0.2%)100.0(100.0-100.0)0 (0.0%)§ 2 (0.3%)100.0(100.0-100.0)§
<1 year
Total306 (100.0%)63.4(57.9-68.9)422 (100.0%)64.8(60.1-69.4)397 (100.0%)75.5(71.2-79.9)0.9 (0.6-1.3)
Leukemias53 (17.3%)21.8(10.4-33.2)73 (17.3%)29.5(18.9-40.1)58 (14.6%)50.2(37.1-63.2)§
 ALL26 (8.5%)19.5(4.1-34.9)41 (9.7%)29.6(15.5-43.7)28 (7.1%)57.4(38.9-75.9)§
 AML15 (4.9%)20.3(0**-40.8)23 (5.5%)26.3(8.2-44.4)23 (5.8%)39.0(18.7-59.3)§
 Other/unspecified leukemias12 (3.9%)28.8(1.5-56.0)9 (2.1%)37.8(3.9-71.7)7 (1.8%)57.5(20.4-94.5)§
Hodgkin lymphoma0 (0.0%)§ 1 (0.2%)100.0(100.0-100.0)0 (0.0%)§ §
Non-Hodgkin lymphoma4 (1.3%)0.0(0.0-0.0)3 (0.7%)66.8(13.0-100**)2 (0.5%)0.0(0.0-0.0)§
CNS tumors34 (11.1%)38.8(22.2-55.3)64 (15.2%)48.1(35.6-60.6)59 (14.9%)56.4(43.6-69.2)§
 Ependymoma8 (2.6%)0.0(0.0-0.0)8 (1.9%)12.6(0**-35.8)3 (0.8%)67.1(13.4-100**)§
 Astrocytoma10 (3.3%)40.5(9.7-71.3)28 (6.6%)67.5(49.5-85.5)19 (4.8%)79.7(61.2-98.2)§
 PNET5 (1.6%)40.3(0**-83.9)18 (4.3%)22.4(3.0-41.8)25 (6.3%)28.2(10.5-46.0)§
 Other gliomas6 (2.0%)67.6(29.3-100**)5 (1.2%)100.0(100.0-100.0)6 (1.5%)100.0(100.0-100.0)§
 Other/unspecified CNS tumors5 (1.6%)60.4(16.9-100**)5 (1.2%)40.5(-3.0-83.9)6 (1.5%)50.6(10.1-91.0)§
Neuroblastoma87 (28.4%)85.1(77.2-92.9)102 (24.2%)76.9(68.4-85.3)99 (24.9%)92.5(87.0-98.0)§
Retinoblastoma32 (10.5%)100.0(100.0-100.0)49 (11.6%)90.9(82.2-99.5)49 (12.3%)100.0(100.0-100.0)§
Wilms tumor42 (13.7%)82.2(70.1-94.2)37 (8.8%)92.5(83.6-100**)32 (8.1%)97.6(91.5-100**)§
Hepatoblastoma13 (4.2%)31.2(5.7-56.6)20 (4.7%)60.6(38.9-82.3)18 (4.5%)71.6(50.0-93.2)§
Osteosarcoma0 (0.0%)§ 0 (0.0%)§ 0 (0.0%)§ §
Ewing sarcoma1 (0.3%)0.0(0.0-0.0)0 (0.0%)§ 0 (0.0%)§ §
Rhabdomyosarcoma8 (2.6%)63.4(29.3-97.5)14 (3.3%)36.1(10.7-61.4)12 (3.0%)42.0(13.9-70.2)§
Non-rhabdomyosarcoma soft tissue sarcomas8 (2.6%)75.4(45.0-100**)21 (5.0%)77.1(58.6-95.5)10 (2.5%)60.4(29.8-91.0)§
Germ cell tumors8 (2.6%)76.3(45.7-100**)22 (5.2%)77.7(59.7-95.6)37 (9.3%)86.4(74.5-98.3)§
Thyroid carcinoma0 (0.0%)§ 0 (0.0%)§ 0 (0.0%)§ §
Melanoma3 (1.0%)100.0(100.0-100.0)1 (0.2%)100.0(100.0-100.0)2 (0.5%)100.0(100.0-100.0)§
1-4 years
Total1011 (100.0%)60.0(56.9-63.0)1267 (100.0%)73.1(70.6-75.6)1460 (100.0%)79.2(77.1-81.3)1.3 (1.0-1.5)
Leukemias417 (41.2%)64.5(59.9-69.1)535 (42.2%)77.9(74.4-81.5)620 (42.5%)86.8(84.1-89.5)1.2 (0.8-1.6)
 ALL342 (33.8%)70.5(65.6-75.4)461 (36.4%)84.4(81.1-87.8)536 (36.7%)91.9(89.5-94.2)1.1 (0.7-1.4)
 AML35 (3.5%)19.1(5.8-32.4)47 (3.7%)32.7(19.2-46.3)73 (5.0%)50.3(38.7-61.9)§
 Other/unspecified leukemias40 (4.0%)52.6(37.1-68.1)27 (2.1%)44.5(25.7-63.3)11 (0.8%)81.9(59.1-100**)§
Hodgkin lymphoma5 (0.5%)80.0(44.9-100**)3 (0.2%)100.0(100.0-100.0)4 (0.3%)100.0(100.0-100.0)§
Non-Hodgkin lymphoma53 (5.2%)43.5(30.1-56.8)39 (3.1%)69.3(54.8-83.8)38 (2.6%)73.7(59.7-87.7)§
CNS tumors155 (15.3%)55.5(47.7-63.4)261 (20.6%)60.2(54.2-66.2)274 (18.8%)71.0(65.6-76.5)0.8 (0.2-1.5)
 Ependymoma24 (2.4%)36.7(17.1-56.4)45 (3.6%)46.1(31.4-60.8)39 (2.7%)69.3(54.8-83.8)§
 Astrocytoma47 (4.6%)78.9(67.1-90.6)100 (7.9%)77.9(69.6-86.1)124 (8.5%)90.2(84.8-95.5)§
 PNET43 (4.3%)48.9(34.0-63.9)64 (5.1%)46.9(34.7-59.2)80 (5.5%)54.2(43.2-65.3)−0.4 (−1.8-1.0)
 Other gliomas37 (3.7%)45.9(29.7-62.0)42 (3.3%)61.6(46.7-76.4)25 (1.7%)40.0(20.8-59.3)§
 Other/unspecified CNS tumors4 (0.4%)50.0(0.9-99.1)10 (0.8%)30.0(1.6-58.5)6 (0.4%)40.0(0**-83.0)§
Neuroblastoma112 (11.1%)31.3(22.7-39.9)128 (10.1%)52.0(43.3-60.7)164 (11.2%)55.0(47.2-62.7)2.2 (1.0-3.4)
Retinoblastoma52 (5.1%)86.7(77.4-96.0)50 (3.9%)91.9(84.1-99.6)54 (3.7%)91.9(84.3-99.6)§
Wilms tumor96 (9.5%)74.1(65.3-82.9)107 (8.4%)94.5(90.1-98.8)141 (9.7%)90.7(85.8-95.5)0.3 (−0.1-0.8)
Hepatoblastoma9 (0.9%)55.6(23.1-88.2)16 (1.3%)62.6(38.8-86.4)34 (2.3%)58.7(42.1-75.4)§
Osteosarcoma4 (0.4%)0.0(0.0-0.0)0 (0.0%)§ 1 (0.1%)100.0(100.0-100.0)§
Ewing sarcoma6 (0.6%)50.1(10.0-90.2)2 (0.2%)0.0(0.0-0.0)4 (0.3%)75.0(32.6-100**)§
Rhabdomyosarcoma33 (3.3%)66.4(50.1-82.7)44 (3.5%)81.9(70.5-93.3)51 (3.5%)72.4(60.0-84.7)§
Non-rhabdomyosarcoma soft tissue sarcomas17 (1.7%)64.8(42.0-87.5)11 (0.9%)41.6(10.9-72.3)17 (1.2%)86.7(69.5-100**)§
Germ cell tumors26 (2.6%)65.5(47.1-83.8)31 (2.4%)93.6(85.0-100**)27 (1.8%)92.7(82.8-100**)§
Thyroid carcinoma1 (0.1%)100.0(100.0-100.0)1 (0.1%)100.0(100.0-100.0)0 (0.0%)§ §
Melanoma2 (0.2%)100.0(100.0-100.0)7 (0.6%)71.5(37.9-100**)1 (0.1%)0.0(0.0-0.0)§
5-9 years
Total847 (100.0%)59.5(56.1-62.8)955 (100.0%)70.9(68.0-73.8)1005 (100.0%)78.1(75.5-80.6)1.2 (1.0-1.5)
Leukemias263 (31.1%)54.3(48.2-60.3)311 (32.6%)73.9(69.0-78.8)357 (35.5%)80.6(76.5-84.8)1.3 (0.9-1.8)
 ALL196 (23.1%)58.8(51.8-65.7)252 (26.4%)79.7(74.7-84.7)306 (30.4%)84.3(80.2-88.5)1.0 (0.6-1.5)
 AML39 (4.6%)37.2(21.8-52.5)37 (3.9%)46.0(29.9-62.0)43 (4.3%)53.5(38.6-68.4)§
 Other/unspecified leukemias28 (3.3%)46.5(28.0-65.0)22 (2.3%)54.6(33.8-75.4)8 (0.8%)87.5(64.6-100**)§
Hodgkin lymphoma47 (5.5%)87.0(77.3-96.8)42 (4.4%)85.6(75.0-96.3)24 (2.4%)100.0(100.0-100.0)§
Non-Hodgkin lymphoma79 (9.3%)50.7(39.7-61.7)77 (8.1%)72.6(62.5-82.6)84 (8.4%)84.5(76.8-92.3)§
CNS tumors233 (27.5%)58.9(52.5-65.2)281 (29.4%)63.7(58.1-69.4)281 (28.0%)73.0(67.8-78.3)1.1 (0.6-1.7)
 Ependymoma10 (1.2%)30.0(1.6-58.5)13 (1.4%)68.4(42.6-94.2)17 (1.7%)75.1(53.8-96.3)§
 Astrocytoma109 (12.9%)77.8(70.0-85.7)145 (15.2%)70.0(62.5-77.6)122 (12.1%)86.0(79.8-92.2)0.7 (0.1-1.4)
 PNET54 (6.4%)38.9(25.9-52.0)65 (6.8%)64.1(52.4-75.9)87 (8.7%)74.5(65.3-83.7)2.0 (1.0-3.0)
 Other gliomas55 (6.5%)48.2(34.9-61.6)51 (5.3%)45.1(31.5-58.8)52 (5.2%)38.5(25.2-51.7)−1.0 (−2.6-0.7)
 Other/unspecified CNS tumors5 (0.6%)40.0(0**-83.0)7 (0.7%)57.2(20.5-93.9)3 (0.3%)100.0(100.0-100.0)§
Neuroblastoma26 (3.1%)61.6(42.9-80.3)24 (2.5%)33.4(14.5-52.2)25 (2.5%)51.5(31.6-71.3)§
Retinoblastoma3 (0.4%)100.0(100.0-100.0)6 (0.6%)100.0(100.0-100.0)6 (0.6%)100.0(100.0-100.0)§
Wilms tumor37 (4.4%)73.0(58.7-87.4)54 (5.7%)87.1(78.1-96.1)42 (4.2%)90.5(81.6-99.4)§
Hepatoblastoma2 (0.2%)50.0(0**-100**)0 (0.0%)§ 6 (0.6%)50.0(10.0-90.1)§
Osteosarcoma12 (1.4%)33.4(6.7-60.1)18 (1.9%)61.1(38.6-83.7)25 (2.5%)64.0(45.2-82.9)§
Ewing sarcoma16 (1.9%)68.8(46.1-91.5)19 (2.0%)68.1(46.9-89.3)17 (1.7%)76.5(56.3-96.7)§
Rhabdomyosarcoma40 (4.7%)52.0(36.4-67.7)43 (4.5%)58.2(43.4-73.0)43 (4.3%)69.2(55.3-83.2)§
Non-rhabdomyosarcoma soft tissue sarcomas27 (3.2%)59.0(40.3-77.7)20 (2.1%)85.0(69.4-100**)33 (3.3%)78.8(64.9-92.8)§
Germ cell tumors18 (2.1%)72.3(51.5-93.0)21 (2.2%)76.2(58.0-94.5)19 (1.9%)89.5(75.7-100**)§
Thyroid carcinoma11 (1.3%)100.0(100.0-100.0)5 (0.5%)100.0(100.0-100.0)8 (0.8%)100.0(100.0-100.0)§
Melanoma7 (0.8%)57.2(20.5-93.9)8 (0.8%)100.0(100.0-100.0)7 (0.7%)100.0(100.0-100.0)§
10-14 years
Total960 (100.0%)59.4(56.3-62.5)887 (100.0%)69.5(66.4-72.5)1142 (100.0%)79.3(77.0-81.7)1.4 (1.1-1.7)
Leukemias189 (19.7%)35.8(29.0-42.7)194 (21.9%)53.9(46.8-60.9)239 (20.9%)67.1(61.1-73.0)3.0 (1.9-4.0)
 ALL118 (12.3%)45.6(36.5-54.6)129 (14.5%)61.9(53.5-70.4)160 (14.0%)77.0(70.4-83.6)2.4 (1.4-3.4)
 AML51 (5.3%)11.8(2.9-20.7)43 (4.8%)33.5(19.2-47.8)61 (5.3%)41.0(28.7-53.4)§
 Other/unspecified leukemias20 (2.1%)40.1(18.6-61.6)22 (2.5%)45.6(24.7-66.4)18 (1.6%)66.8(45.0-88.6)§
Hodgkin disease139 (14.5%)80.1(73.4-86.8)101 (11.4%)91.2(85.6-96.8)110 (9.6%)95.6(91.7-99.5)§
Non-Hodgkin lymphoma77 (8.0%)46.9(35.7-58.1)84 (9.5%)68.0(57.9-78.0)105 (9.2%)86.8(80.2-93.3)§
CNS tumors197 (20.5%)62.5(55.7-69.3)180 (20.3%)67.0(60.1-74.0)247 (21.6%)80.1(75.0-85.1)1.3 (0.9-1.8)
 Ependymoma11 (1.1%)45.5(16.0-75.1)12 (1.4%)83.4(62.3-100**)16 (1.4%)73.4(51.0-95.9)§
 Astrocytoma107 (11.1%)67.4(58.5-76.4)108 (12.2%)72.1(63.6-80.7)125 (10.9%)83.9(77.4-90.4)0.8 (0.2-1.3)
 PNET34 (3.5%)59.0(42.4-75.6)24 (2.7%)50.1(30.0-70.1)49 (4.3%)81.4(70.3-92.5)§
 Other gliomas38 (4.0%)55.4(39.6-71.3)30 (3.4%)50.1(32.1-68.0)51 (4.5%)72.6(60.3-84.9)§
 Other/unspecified CNS tumors7 (0.7%)66.8(29.0-100**)6 (0.7%)100.0(100.0-100.0)6 (0.5%)66.7(28.9-100**)§
Neuroblastoma12 (1.3%)33.4(6.7-60.1)8 (0.9%)37.5(3.9-71.2)4 (0.4%)75.0(32.5-100**)§
Retinoblastoma1 (0.1%)100.0(100.0-100.0)0 (0.0%)§ 1 (0.1%)100.0(100.0-100.0)§
Wilms tumor8 (0.8%)62.6(28.9-96.3)8 (0.9%)87.5(64.5-100**)6 (0.5%)83.4(53.6-100**)§
Hepatoblastoma0 (0.0%)§ 1 (0.1%)100.0(100.0-100.0)1 (0.1%)0.0(0.0-0.0)§
Osteosarcoma58 (6.0%)46.6(33.8-59.5)62 (7.0%)67.9(56.3-79.6)75 (6.6%)69.5(59.0-79.9)§
Ewing sarcoma32 (3.3%)46.6(29.1-64.0)35 (3.9%)57.2(40.8-73.7)31 (2.7%)74.3(58.9-89.8)§
Rhabdomyosarcoma26 (2.7%)42.4(23.4-61.5)24 (2.7%)37.6(18.1-57.0)30 (2.6%)63.4(46.1-80.7)§
Non-rhabdomyosarcoma soft tissue sarcomas58 (6.0%)76.1(65.0-87.1)52 (5.9%)84.5(74.5-94.5)81 (7.1%)82.5(74.1-90.9)§
Germ cell tumors40 (4.2%)77.6(64.6-90.6)35 (3.9%)82.9(70.4-95.4)69 (6.0%)92.7(86.5-98.9)§
Thyroid carcinoma33 (3.4%)100.0(100.0-100.0)36 (4.1%)97.4(92.0-100**)31 (2.7%)93.4(84.5-100**)§
Melanoma18 (1.9%)89.0(74.4-100**)21 (2.4%)76.4(58.1-94.6)32 (2.8%)84.5(71.9-97.1)§
15-19 years
Total1784 (100.0%)68.1(65.9-70.3)1665 (100.0%)77.4(75.4-79.5)1746 (100.0%)80.9(79.0-82.7)0.8 (0.6-1.0)
Leukemias214 (12.0%)25.9(20.0-31.7)171 (10.3%)44.5(37.0-52.0)190 (10.9%)52.8(45.7-60.0)2.7 (1.5-3.8)
 ALL102 (5.7%)29.6(20.7-38.5)96 (5.8%)53.2(43.1-63.2)105 (6.0%)59.3(49.9-68.8)2.6 (1.1-4.1)
 AML70 (3.9%)20.1(10.7-29.5)53 (3.2%)37.8(24.7-51.0)67 (3.8%)38.9(27.2-50.7)§
 Other/unspecified leukemias42 (2.4%)26.3(13.0-39.7)22 (1.3%)22.8(5.2-40.4)18 (1.0%)66.8(44.9-88.7)§
Hodgkin lymphoma373 (20.9%)89.7(86.6-92.9)319 (19.2%)90.1(86.7-93.4)302 (17.3%)95.7(93.3-98.1)§
Non-Hodgkin lymphoma106 (5.9%)47.1(37.5-56.7)125 (7.5%)66.3(57.9-74.7)142 (8.1%)77.0(70.0-84.0)1.3 (0.1-2.6)
CNS tumors182 (10.2%)60.6(53.4-67.7)176 (10.6%)77.0(70.7-83.3)161 (9.2%)80.4(74.2-86.6)1.2 (0.6-1.7)
 Ependymoma7 (0.4%)71.7(38.0-100**)10 (0.6%)100.0(100.0-100.0)13 (0.7%)84.8(65.1-100**)§
 Astrocytoma117 (6.6%)60.1(51.2-69.0)114 (6.8%)73.1(64.9-81.3)90 (5.2%)81.3(73.1-89.4)1.3 (0.7-1.9)
 PNET16 (0.9%)50.3(25.6-75.0)19 (1.1%)84.0(67.2-100**)15 (0.9%)73.6(51.1-96.0)§
 Other gliomas32 (1.8%)68.6(52.2-84.9)27 (1.6%)81.6(66.9-96.3)40 (2.3%)77.7(64.7-90.7)§
 Other/unspecified CNS tumors10 (0.6%)50.2(19.1-81.4)6 (0.4%)66.9(29.1-100**)3 (0.2%)100.0(100.0-100.0)§
Neuroblastoma5 (0.3%)60.1(16.9-100**)8 (0.5%)25.2(0**-55.4)5 (0.3%)60.1(17.0-100**)§
Retinoblastoma0 (0.0%)§ 1 (0.1%)100.0(100.0-100.0)1 (0.1%)100.0(100.0-100.0)§
Wilms tumor2 (0.1%)50.0(0**-100**)1 (0.1%)100.0(100.0-100.0)2 (0.1%)100.0(100.0-100.0)§
Hepatoblastoma1 (0.1%)100.0(100.0-100.0)1 (0.1%)0.0(0.0-0.0)0 (0.0%)§ §
Osteosarcoma63 (3.5%)49.5(37.1-61.9)75 (4.5%)58.9(47.7-70.1)73 (4.2%)60.4(49.1-71.7)0.8 (−0.9-2.4)
Ewing sarcoma39 (2.2%)28.3(14.1-42.6)38 (2.3%)55.0(39.0-71.0)32 (1.8%)53.3(36.0-70.7)§
Rhabdomyosarcoma33 (1.8%)30.5(14.7-46.3)32 (1.9%)59.0(41.7-76.3)31 (1.8%)45.3(27.7-62.9)§
Non-rhabdomyosarcoma soft tissue sarcomas105 (5.9%)82.3(74.9-89.7)102 (6.1%)78.4(70.2-86.6)119 (6.8%)76.6(68.9-84.3)−0.5 (−1.2-0.1)
Germ cell tumors227 (12.7%)71.2(65.3-77.2)223 (13.4%)87.4(82.9-91.8)226 (12.9%)92.9(89.4-96.3)0.8 (0.4-1.1)
Thyroid carcinoma129 (7.2%)99.3(97.8-100**)127 (7.6%)98.7(96.5-100**)164 (9.4%)99.0(97.3-100**)§
Melanoma125 (7.0%)82.7(75.9-89.4)125 (7.5%)93.0(88.4-97.7)131 (7.5%)95.6(92.0-99.2)§
Table 6. 10-Year Relative Survival Rates of Childhood and Adolescent Cancers in SEER 9 Registries by Subgroup for Diagnosis Years 1975-1984 and 1985-1994
Cancer1975-19841985-1994
No. (%)10-Year Survival Rate (%)*95% CINo. (%)10-Year Survival Rate (%)*95% CI
  • *

    10-year relative survival rate calculated via actuarial method.

  • 95% CI: 95% confidence interval.

  • The frequencies and percentages in a column will not sum to those found in the “Total” row, as only the most common cancers are reported.

  • §

    The statistic could not be calculated.

  • Survival curve is significantly different from 1975-1984 curve (p < 0.05).

  • **

    Upper confidence level truncated at 100% and/or lower confidence level truncated at 0%.

Male
Total5192 (100.0%)57.2(55.9-58.6)5756 (100.0%)69.5(68.3-70.7)
Leukemias1295 (24.9%)42.3(39.6-45.0)1466 (25.5%)61.9(59.4-64.4)
 Acute lymphoblastic leukemia (ALL)935 (18.0%)49.4(46.2-52.7)1118 (19.4%)70.6(67.9-73.3)
 Acute myeloid leukemia (AML)207 (4.0%)18.0(12.7-23.3)224 (3.9%)31.7(25.5-37.9)
 Other/unspecified leukemias153 (2.9%)31.2(23.8-38.7)124 (2.2%)37.4(28.8-46.1)
Hodgkin lymphoma542 (10.4%)80.6(77.1-84.0)457 (7.9%)87.6(84.4-90.8)
Non-Hodgkin lymphoma465 (9.0%)51.2(46.6-55.8)456 (7.9%)71.8(67.5-76.0)
Central Nervous System (CNS) tumors853 (16.4%)53.0(49.6-56.4)1126 (19.6%)64.7(61.8-67.5)
 Ependymoma67 (1.3%)29.8(18.7-40.9)105 (1.8%)48.4(38.7-58.1)
 Astrocytoma424 (8.2%)64.9(60.3-69.5)545 (9.5%)75.6(71.9-79.3)
 Primitive neuroectodermal tumors (PNET)179 (3.4%)40.0(32.7-47.2)256 (4.4%)54.2(48.0-60.4)
 Other gliomas146 (2.8%)50.0(41.8-58.2)190 (3.3%)58.7(51.6-65.8)
 Other/unspecified CNS tumors37 (0.7%)34.0(18.4-49.7)30 (0.5%)50.2(32.2-68.2)
Neuroblastoma (extracranial)255 (4.9%)48.4(42.2-54.6)312 (5.4%)61.2(55.7-66.8)
Retinoblastoma84 (1.6%)91.1(84.6-97.5)125 (2.2%)94.9(90.7-99.1)
Wilms tumor184 (3.5%)77.6(71.5-83.7)216 (3.8%)90.1(86.1-94.2)
Hepatoblastoma31 (0.6%)55.3(37.6-73.0)45 (0.8%)62.2(47.8-76.6)
Osteosarcoma156 (3.0%)40.7(32.9-48.5)180 (3.1%)55.0(47.6-62.3)
Ewing sarcoma128 (2.5%)33.5(25.2-41.8)112 (1.9%)44.0(34.6-53.4)
Rhabdomyosarcoma158 (3.0%)53.5(45.6-61.4)195 (3.4%)66.4(59.7-73.1)
Non-rhabdomyosarcoma soft tissue sarcomas213 (4.1%)72.9(66.8-79.1)207 (3.6%)72.8(66.6-79.1)
Germ cell tumors387 (7.5%)73.5(69.0-78.0)396 (6.9%)83.9(80.2-87.7)
Thyroid carcinoma74 (1.4%)99.2(96.5-100**)54 (0.9%)95.1(88.9-100**)
Malignant melanoma106 (2.0%)75.1(66.5-83.7)128 (2.2%)83.1(76.3-89.9)
Female
Total4625 (100.0%)65.5(64.1-66.9)4906 (100.0%)74.5(73.3-75.7)
Leukemias1034 (22.4%)49.8(46.7-52.9)1150 (23.4%)67.9(65.2-70.6)
 ALL736 (15.9%)60.3(56.7-63.8)835 (17.0%)76.5(73.6-79.4)
 AML197 (4.3%)21.3(15.5-27.0)232 (4.7%)42.7(36.3-49.1)
 Other/unspecified leukemias101 (2.2%)29.2(20.3-38.2)83 (1.7%)52.4(41.5-63.3)
Hodgkin lymphoma509 (11.0%)81.6(78.2-85.0)439 (8.9%)90.3(87.5-93.2)
Non-Hodgkin lymphoma184 (4.0%)56.8(49.6-64.1)218 (4.4%)70.7(64.6-76.8)
CNS tumors700 (15.1%)56.8(53.1-60.5)880 (17.9%)61.7(58.5-65.0)
 Ependymoma46 (1.0%)36.4(22.3-50.5)57 (1.2%)50.2(37.0-63.4)
 Astrocytoma357 (7.7%)64.8(59.8-69.8)487 (9.9%)72.9(68.9-76.9)
 PNET123 (2.7%)55.5(46.6-64.3)151 (3.1%)47.1(39.1-55.1)
 Other gliomas150 (3.2%)44.2(36.1-52.2)155 (3.2%)49.1(41.2-57.0)
 Other/unspecified CNS tumors24 (0.5%)62.6(43.2-82.1)30 (0.6%)41.6(23.6-59.7)
Neuroblastoma245 (5.3%)55.0(48.7-61.3)258 (5.3%)64.8(58.8-70.7)
Retinoblastoma100 (2.2%)92.6(87.2-98.0)118 (2.4%)90.8(85.2-96.3)
Wilms tumor216 (4.7%)81.8(76.6-87.1)224 (4.6%)92.1(88.5-95.7)
Hepatoblastoma25 (0.5%)38.7(18.8-58.6)40 (0.8%)60.3(45.1-75.6)
Osteosarcoma136 (2.9%)50.1(41.7-58.6)133 (2.7%)65.2(57.0-73.4)
Ewing sarcoma86 (1.9%)48.2(37.5-58.9)86 (1.8%)60.3(49.9-70.8)
Rhabdomyosarcoma118 (2.6%)54.2(45.1-63.2)122 (2.5%)61.4(52.7-70.1)
Non-rhabdomyosarcoma soft tissue sarcomas221 (4.8%)74.4(68.5-80.2)194 (4.0%)73.1(66.8-79.4)
Germ cell tumors284 (6.1%)78.9(74.1-83.7)300 (6.1%)86.9(83.0-90.8)
Thyroid carcinoma270 (5.8%)97.8(95.9-99.8)274 (5.6%)99.3(98.0-100**)
Melanoma177 (3.8%)85.4(80.0-90.7)202 (4.1%)94.3(91.0-97.7)
White
Total8266 (100.0%)61.8(60.7-62.9)8572 (100.0%)73.1(72.2-74.1)
Leukemias1957 (23.7%)47.0(44.7-49.2)2074 (24.2%)66.4(64.3-68.4)
 ALL1423 (17.2%)55.6(53.0-58.2)1594 (18.6%)74.2(72.0-76.4)
 AML321 (3.9%)18.7(14.4-23.0)330 (3.8%)39.0(33.7-44.3)
 Other/unspecified leukemias213 (2.6%)31.2(24.9-37.4)150 (1.7%)43.4(35.3-51.4)
Hodgkin lymphoma947 (11.5%)81.4(78.9-84.0)785 (9.2%)89.3(87.1-91.5)
Non-Hodgkin lymphoma564 (6.8%)52.1(48.0-56.3)552 (6.4%)72.4(68.6-76.2)
CNS tumors1319 (16.0%)55.6(52.9-58.3)1628 (19.0%)64.6(62.2-66.9)
 Ependymoma97 (1.2%)35.8(26.2-45.5)126 (1.5%)49.6(40.7-58.5)
 Astrocytoma689 (8.3%)65.3(61.7-68.9)843 (9.8%)75.0(72.1-78.0)
 PNET240 (2.9%)45.2(38.9-51.6)340 (4.0%)52.0(46.6-57.3)
 Other gliomas240 (2.9%)48.8(42.4-55.2)270 (3.1%)58.2(52.3-64.2)
 Other/unspecified CNS tumors53 (0.6%)42.9(29.4-56.5)49 (0.6%)46.1(32.0-60.3)
Neuroblastoma423 (5.1%)52.5(47.7-57.3)461 (5.4%)63.2(58.7-67.7)
Retinoblastoma139 (1.7%)91.2(86.2-96.1)182 (2.1%)93.6(89.8-97.4)
Wilms tumor321 (3.9%)79.8(75.3-84.2)358 (4.2%)92.1(89.3-94.9)
Hepatoblastoma48 (0.6%)50.1(35.7-64.4)66 (0.8%)62.4(50.6-74.2)
Osteosarcoma214 (2.6%)43.7(36.9-50.4)230 (2.7%)59.4(52.9-65.8)
Ewing sarcoma199 (2.4%)38.8(31.9-45.7)180 (2.1%)51.3(43.8-58.7)
Rhabdomyosarcoma234 (2.8%)54.8(48.4-61.3)244 (2.8%)64.9(58.9-70.9)
Non-rhabdomyosarcoma soft tissue sarcomas333 (4.0%)73.4(68.5-78.2)286 (3.3%)75.0(69.9-80.1)
Germ cell tumors571 (6.9%)75.8(72.2-79.4)541 (6.3%)86.4(83.4-89.4)
Thyroid carcinoma297 (3.6%)98.6(97.0-100**)273 (3.2%)98.2(96.5-100.0)
Melanoma266 (3.2%)80.4(75.5-85.4)306 (3.6%)89.6(86.1-93.2)
Black
Total936 (100.0%)56.3(53.1-59.5)1130 (100.0%)64.5(61.7-67.3)
Leukemias187 (20.0%)32.4(25.6-39.1)236 (20.9%)53.1(46.7-59.6)
 ALL115 (12.3%)38.6(29.6-47.5)144 (12.7%)61.9(53.9-70.0)
 AML45 (4.8%)22.3(10.0-34.6)60 (5.3%)38.5(26.1-50.9)
 Other/unspecified leukemias27 (2.9%)22.4(6.5-38.3)32 (2.8%)40.4(23.0-57.7)
Hodgkin lymphoma76 (8.1%)77.4(67.7-87.1)89 (7.9%)82.9(74.8-91.0)
Non-Hodgkin lymphoma52 (5.6%)48.5(34.7-62.3)63 (5.6%)71.8(60.4-83.1)
CNS tumors152 (16.2%)49.8(41.8-57.8)244 (21.6%)57.5(51.2-63.8)
 Ependymoma10 (1.1%)10.1(0**-28.8)25 (2.2%)48.2(28.5-67.9)
 Astrocytoma62 (6.6%)62.0(49.7-74.3)129 (11.4%)68.5(60.4-76.6)
 PNET33 (3.5%)54.8(37.6-71.9)38 (3.4%)47.6(31.6-63.6)
 Other gliomas42 (4.5%)38.4(23.6-53.2)45 (4.0%)39.3(24.8-53.8)
 Other/unspecified CNS tumors5 (0.5%)40.3(0**-84.0)7 (0.6%)57.6(20.5-94.7)
Neuroblastoma54 (5.8%)42.8(29.4-56.2)58 (5.1%)57.3(44.3-70.2)
Retinoblastoma26 (2.8%)93.1(82.5-100**)35 (3.1%)92.4(82.8-100**)
Wilms tumor63 (6.7%)76.8(66.2-87.4)60 (5.3%)88.6(80.3-96.9)
Hepatoblastoma5 (0.5%)40.2(0**-83.6)9 (0.8%)33.6(2.5-64.7)
Osteosarcoma48 (5.1%)52.4(38.1-66.7)41 (3.6%)54.1(38.5-69.7)
Ewing sarcoma5 (0.5%)60.1(16.6-100**)3 (0.3%)33.5(0**-87.3)
Rhabdomyosarcoma27 (2.9%)48.4(29.3-67.4)52 (4.6%)61.7(48.4-75.0)
Non-rhabdomyosarcoma soft tissue sarcomas65 (6.9%)69.6(58.0-81.1)64 (5.7%)61.4(49.2-73.6)
Germ cell tumors54 (5.8%)81.8(71.3-92.2)73 (6.5%)84.3(75.6-92.9)
Thyroid carcinoma17 (1.8%)94.8(83.5-100**)19 (1.7%)100.0(100.0-100.0)
Melanoma2 (0.2%)100.0(100.0-100.0)0 (0.0%)§ 
<1 year
Total661 (100.0%)63.5(59.7-67.3)852 (100.0%)68.7(65.5-71.9)
Leukemias112 (16.9%)21.7(13.9-29.5)132 (15.5%)37.6(29.2-46.0)
 ALL58 (8.8%)26.1(14.7-37.6)69 (8.1%)36.6(25.1-48.1)
 AML32 (4.8%)21.4(6.8-36.0)41 (4.8%)34.0(19.3-48.8)
 Other/unspecified leukemias22 (3.3%)10.0(0**-23.2)22 (2.6%)48.2(26.6-69.8)
Hodgkin lymphoma0 (0.0%)§ 1 (0.1%)100.0(100.0-100.0)
Non-Hodgkin lymphoma6 (0.9%)0.0(0.0-0.0)5 (0.6%)60.2(16.7-100**)
CNS tumors81 (12.3%)33.7(23.3-44.2)122 (14.3%)45.7(36.7-54.7)
 Ependymoma12 (1.8%)0.0(0.0-0.0)18 (2.1%)22.5(3.0-41.9)
 Astrocytoma29 (4.4%)31.5(14.4-48.6)46 (5.4%)76.3(63.6-89.1)
 PNET17 (2.6%)41.8(18.0-65.5)37 (4.3%)16.4(4.4-28.4)
 Other gliomas13 (2.0%)54.6(27.1-82.1)12 (1.4%)59.0(30.8-87.2)
 Other/unspecified CNS tumors10 (1.5%)40.5(9.6-71.3)9 (1.1%)45.0(12.1-77.9)
Neuroblastoma186 (28.1%)82.9(77.2-88.5)239 (28.1%)82.6(77.6-87.6)
Retinoblastoma78 (11.8%)98.8(95.1-100**)109 (12.8%)90.6(84.7-96.6)
Wilms tumor70 (10.6%)84.1(75.1-93.1)66 (7.7%)90.3(82.8-97.9)
Hepatoblastoma22 (3.3%)46.1(24.9-67.2)37 (4.3%)65.4(49.9-81.0)
Osteosarcoma0 (0.0%)§ 0 (0.0%)§ 
Ewing sarcoma1 (0.2%)0.0(0.0-0.0)0 (0.0%)§ 
Rhabdomyosarcoma20 (3.0%)60.8(39.0-82.6)19 (2.2%)41.8(19.1-64.5)
Non-rhabdomyosarcoma soft tissue sarcomas22 (3.3%)78.4(60.6-96.2)30 (3.5%)84.3(70.8-97.8)
Germ cell tumors30 (4.5%)67.1(49.7-84.5)55 (6.5%)73.2(61.2-85.2)
Thyroid carcinoma0 (0.0%)§ 0 (0.0%)§ 
Melanoma4 (0.6%)100.0(100.0-100.0)3 (0.4%)100.0(100.0-100.0)
1-4 years
Total2135 (100.0%)58.7(56.6-60.8)2711 (100.0%)72.4(70.7-74.1)
Leukemias876 (41.0%)59.9(56.7-63.2)1105 (40.8%)75.6(73.1-78.2)
 ALL735 (34.4%)65.1(61.6-68.6)935 (34.5%)81.6(79.1-84.1)
 AML75 (3.5%)25.4(15.4-35.4)118 (4.4%)37.7(28.9-46.5)
 Other/unspecified leukemias66 (3.1%)41.0(29.1-52.9)52 (1.9%)53.7(40.0-67.3)
Hodgkin lymphoma5 (0.2%)80.0(44.9-100**)11 (0.4%)100.0(100.0-100.0)
Non-Hodgkin lymphoma91 (4.3%)47.8(37.4-58.2)93 (3.4%)74.3(65.4-83.2)
CNS tumors345 (16.2%)53.9(48.6-59.2)555 (20.5%)59.3(55.1-63.4)
 Ependymoma48 (2.2%)34.9(21.3-48.6)83 (3.1%)38.9(28.2-49.6)
 Astrocytoma128 (6.0%)75.9(68.4-83.4)221 (8.2%)80.0(74.7-85.4)
 PNET94 (4.4%)45.8(35.7-55.9)135 (5.0%)46.7(38.3-55.2)
 Other gliomas61 (2.9%)37.6(25.3-49.8)97 (3.6%)54.5(44.6-64.5)
 Other/unspecified CNS tumors14 (0.7%)42.9(16.9-68.9)19 (0.7%)21.1(2.7-39.5)
Neuroblastoma236 (11.1%)34.0(27.9-40.0)266 (9.8%)51.3(45.2-57.3)
Retinoblastoma98 (4.6%)86.9(80.1-93.7)120 (4.4%)94.1(89.7-98.5)
Wilms tumor221 (10.4%)80.3(75.0-85.6)245 (9.0%)92.8(89.4-96.1)
Hepatoblastoma27 (1.3%)51.2(32.0-70.4)44 (1.6%)56.8(42.0-71.5)
Osteosarcoma9 (0.4%)22.3(0**-49.5)7 (0.3%)42.9(6.2-79.6)
Ewing sarcoma15 (0.7%)40.1(15.2-64.9)5 (0.2%)40.0(0**-83.1)
Rhabdomyosarcoma72 (3.4%)60.9(49.5-72.3)101 (3.7%)86.3(79.5-93.0)
Non-rhabdomyosarcoma soft tissue sarcomas39 (1.8%)69.0(54.4-83.7)32 (1.2%)71.5(55.6-87.3)
Germ cell tumors54 (2.5%)59.4(46.3-72.6)55 (2.0%)92.8(85.9-99.7)
Thyroid carcinoma1 (0.0%)100.0(100.0-100.0)2 (0.1%)100.0(100.0-100.0)
Melanoma5 (0.2%)100.0(100.0-100.0)10 (0.4%)70.0(41.6-98.5)
5-9 years
Total1602 (100.0%)58.6(56.1-61.0)1888 (100.0%)70.1(68.0-72.1)
Leukemias508 (31.7%)53.6(49.3-58.0)620 (32.8%)70.0(66.3-73.6)
 ALL404 (25.2%)57.6(52.8-62.4)494 (26.2%)76.1(72.3-79.9)
 AML59 (3.7%)34.7(22.4-47.0)86 (4.6%)42.9(32.3-53.4)
 Other/unspecified leukemias45 (2.8%)42.3(27.8-56.8)40 (2.1%)52.3(36.7-67.9)
Hodgkin lymphoma78 (4.9%)82.1(73.4-90.7)65 (3.4%)89.2(81.6-96.9)
Non-Hodgkin lymphoma148 (9.2%)57.0(48.9-65.0)144 (7.6%)77.8(71.0-84.7)
CNS tumors424 (26.5%)55.1(50.3-59.9)571 (30.2%)62.6(58.5-66.6)
 Ependymoma19 (1.2%)31.6(10.6-52.6)25 (1.3%)58.9(39.1-78.6)
 Astrocytoma203 (12.7%)71.7(65.4-78.0)291 (15.4%)71.5(66.2-76.7)
 PNET99 (6.2%)43.5(33.7-53.3)127 (6.7%)62.8(54.4-71.3)
 Other gliomas96 (6.0%)38.9(29.0-48.8)113 (6.0%)41.2(32.0-50.3)
 Other/unspecified CNS tumors7 (0.4%)28.6(0**- 62.2)15 (0.8%)53.4(28.0-78.7)
Neuroblastoma51 (3.2%)37.2(23.9-50.6)43 (2.3%)38.2(23.4-52.9)
Retinoblastoma7 (0.4%)85.7(59.7-100**)11 (0.6%)100.0(100.0-100.0)
Wilms tumor84 (5.2%)79.9(71.3-88.5)110 (5.8%)88.3(82.2-94.3)
Hepatoblastoma3 (0.2%)33.4(0**-86.9)2 (0.1%)100.0(100.0-100.0)
Osteosarcoma28 (1.7%)39.3(21.2-57.5)40 (2.1%)52.6(37.1-68.2)
Ewing sarcoma37 (2.3%)59.0(42.9-75.0)35 (1.9%)65.4(49.5-81.4)
Rhabdomyosarcoma81 (5.1%)57.8(47.0-68.7)82 (4.3%)65.9(55.6-76.2)
Non-rhabdomyosarcoma soft tissue sarcomas52 (3.2%)70.8(58.2-83.4)58 (3.1%)86.3(77.4-95.2)
Germ cell tumors33 (2.1%)72.8(57.5-88.0)35 (1.9%)77.1(63.0-91.2)
Thyroid carcinoma17 (1.1%)100.0(100.0-100.0)12 (0.6%)91.8(76.1-100**)
Melanoma14 (0.9%)78.6(57.1-100**)12 (0.6%)100.0(100.0-100.0)
10-14 years
Total1906 (100.0%)57.9(55.7-60.2)1913 (100.0%)69.9(67.9-72.0)
Leukemias406 (21.3%)33.7(29.1-38.4)392 (20.5%)54.8(49.9-59.8)
 ALL257 (13.5%)44.1(38.0-50.2)265 (13.9%)63.6(57.7-69.4)
 AML107 (5.6%)10.3(4.5-16.1)87 (4.5%)33.9(23.8-44.0)
 Other/unspecified leukemias42 (2.2%)29.7(15.6-43.8)40 (2.1%)41.8(26.2-57.3)
Hodgkin lymphoma248 (13.0%)79.2(74.1-84.4)213 (11.1%)91.6(87.8-95.5)
Non-Hodgkin lymphoma168 (8.8%)54.4(46.8-62.0)177 (9.3%)69.9(63.0-76.7)
CNS tumors365 (19.2%)57.4(52.2-62.5)421 (22.0%)68.9(64.4-73.4)
 Ependymoma19 (1.0%)37.2(15.3-59.0)22 (1.2%)72.9(54.2-91.7)
 Astrocytoma207 (10.9%)65.4(58.8-72.0)261 (13.6%)74.0(68.5-79.4)
 PNET58 (3.0%)45.1(32.2-58.0)64 (3.3%)50.1(37.8-62.5)
 Other gliomas68 (3.6%)50.3(38.4-62.3)65 (3.4%)64.3(52.4-76.1)
 Other/unspecified CNS tumors13 (0.7%)50.7(22.1-79.2)9 (0.5%)76.2(47.0-100**)
Neuroblastoma15 (0.8%)20.1(0**- 40.4)12 (0.6%)48.7(19.5-77.9)
Retinoblastoma1 (0.1%)100.0(100.0-100.0)1 (0.1%)100.0(100.0-100.0)
Wilms tumor18 (0.9%)61.5(38.8-84.3)14 (0.7%)92.9(79.3-100**)
Hepatoblastoma2 (0.1%)50.0(0**-100**)1 (0.1%)100.0(100.0-100.0)
Osteosarcoma117 (6.1%)53.2(44.0-62.3)125 (6.5%)64.0(55.5-72.6)
Ewing sarcoma73 (3.8%)38.0(26.7-49.3)77 (4.0%)52.7(41.3-64.0)
Rhabdomyosarcoma42 (2.2%)52.5(37.3-67.7)55 (2.9%)45.7(32.4-58.9)
Non-rhabdomyosarcoma soft tissue sarcomas114 (6.0%)74.2(66.0-82.3)111 (5.8%)75.8(67.7-84.0)
Germ cell tumors99 (5.2%)79.2(71.1-87.3)89 (4.7%)80.0(71.6-88.4)
Thyroid carcinoma65 (3.4%)98.9(95.9-100**)73 (3.8%)98.8(96.1-100**)
Melanoma35 (1.8%)91.7(82.3-100**)50 (2.6%)86.0(76.0-96.0)
15-19 years
Total3513 (100.0%)65.1(63.5-66.7)3298 (100.0%)74.2(72.7-75.8)
Leukemias427 (12.2%)24.2(20.1-28.3)367 (11.1%)41.8(36.7-46.9)
 ALL217 (6.2%)29.9(23.7-36.1)190 (5.8%)49.5(42.3-56.7)
 AML131 (3.7%)17.0(10.5-23.5)124 (3.8%)36.6(28.0-45.1)
 Other/unspecified leukemias79 (2.2%)20.5(11.5-29.5)53 (1.6%)26.7(14.7-38.6)
Hodgkin lymphoma720 (20.5%)81.6(78.7-84.5)606 (18.4%)87.7(85.0-90.5)
Non-Hodgkin lymphoma236 (6.7%)51.7(45.2-58.2)255 (7.7%)67.9(62.1-73.8)
CNS tumors338 (9.6%)57.2(51.8-62.6)337 (10.2%)71.0(66.1-76.0)
 Ependymoma15 (0.4%)47.2(21.6-72.7)14 (0.4%)86.5(68.0-100**)
 Astrocytoma214 (6.1%)55.6(48.9-62.4)213 (6.5%)72.2(66.1-78.4)
 PNET34 (1.0%)59.6(42.8-76.3)44 (1.3%)65.4(50.9-80.0)
 Other gliomas58 (1.7%)65.4(52.8-78.0)58 (1.8%)67.6(55.3-79.9)
 Other/unspecified CNS tumors17 (0.5%)53.2(29.2-77.2)8 (0.2%)62.8(28.9-96.6)
Neuroblastoma12 (0.3%)25.2(0.5-49.9)10 (0.3%)30.2(1.4-59.0)
Retinoblastoma0 (0.0%)§ 2 (0.1%)100.0(100.0-100.0)
Wilms tumor7 (0.2%)71.6(37.6-100**)5 (0.2%)80.2(44.9-100**)
Hepatoblastoma2 (0.1%)50.0(0**-100**)1 (0.0%)0.0(0.0-0.0)
Osteosarcoma138 (3.9%)40.9(32.6-49.2)141 (4.3%)57.9(49.6-66.1)
Ewing sarcoma88 (2.5%)32.5(22.5-42.4)81 (2.5%)44.4(33.4-55.4)
Rhabdomyosarcoma61 (1.7%)38.0(25.7-50.3)60 (1.8%)49.9(37.0-62.7)
Non-rhabdomyosarcoma soft tissue sarcomas207 (5.9%)74.5(68.4-80.6)170 (5.2%)64.8(57.5-72.2)
Germ cell tumors455 (13.0%)78.0(74.1-81.9)462 (14.0%)87.4(84.2-90.5)
Thyroid carcinoma261 (7.4%)98.0(96.0-100.0)241 (7.3%)98.8(97.2-100**)
Melanoma225 (6.4%)79.4(73.9-84.8)255 (7.7%)90.9(87.2-94.6)

RESULTS

  1. Top of page
  2. Abstract
  3. MATERIALS AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Overall

Five-year survival rates increased significantly for all histologic types combined, from 63% for those diagnosed in 1975 through 1979 to 79% for those diagnosed in 1995 through 1999, or by 1.1% annually during the period 1975 through 1999 (Table 2). Significant increases were observed for most cancer types examined (Fig. 1). The greatest increases were observed for ependymoma (+37%) and non-Hodgkin lymphoma (NHL) (+34%); the smallest increases were observed in Hodgkin lymphoma (HL) (+9%) and melanoma (+10%). Five-year rates were >90% for 6 cancers in 1995 through 1999; children/adolescents with HL (96%), retinoblastoma (97%), and thyroid carcinoma (98%) had the highest rates. Acute myeloid leukemia (AML) patients had the lowest 5-year rates (45%), although they experienced the greatest annual increase over the 25-year period (APC of 3.7%). Annual observed and expected 5-year rates, as determined by joinpoint regression, are shown in Figure 1.

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Figure 1. Observed (data points) and expected (joinpoint regression lines) 5-year relative survival rates from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program 9 registries for children and adolescents ages birth to 19 years diagnosed between 1975 and 1999 with (A) leukemias; (B) central nervous system (CNS) tumors; (C) neuroblastoma, Wilms tumor, rhabdomyosarcoma (RMS), and nonrhabdomyosarcoma soft-tissue sarcomas (NRSTS); and (D) lymphomas, osteosarcoma, Ewing sarcoma, and germ cell tumors. ALL indicates acute lymphoblastic leukemia; AML, acute myeloid leukemia; PNET, primitive neuroectodermal tumor.

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Five-year rates were higher in females than males in the 3 periods examined, although the increase observed from 1975 through 1979 to 1995 through 1999 was greater in males (+20% [APC of 1.4%] vs +13%, [APC of 0.9%] in females). White children/adolescents had higher 5-year rates than black children/adolescents in each period and experienced a greater increase (+17% vs +13%); however, the rates of change were equivalent (APC of 1.1%). Adolescents diagnosed at ages 15 through 19 years in 1995 through 1999 had the highest 5-year rates (81%), whereas infants had the lowest (76%); significant improvements were observed in all age categories (APC<1 of 0.9%, APC1-4 of 1.3%, APC5-9 of 1.2%, APC10-14 of 1.4%, and APC15-19 of 0.8%).

Ten-year survival increased 11% across the 2 diagnostic cohorts (1975-1984: 61% vs 1985-1994: 72%) (Table 3). Significant increases were observed for nearly all cancers; 10-year rates improved the most for acute lymphoblastic leukemia (ALL) (+19%) and NHL (+19%), AML (+18%), and ependymoma (+17%) and improved the least for HL (+8%) and melanoma (+8%). For those diagnosed in 1985 through 1994, the 10-year rates were ≥90% for melanoma (90%), Wilms tumor (91%), retinoblastoma (93%), and thyroid carcinoma (99%); AML patients experienced the poorest survival (37%). The patterns described above for sex, race, and age categories were also observed for 10-year survival, although 10-year rates and increases were smaller in magnitude.

Five-year rates, 95% CIs, and Z-test results for all subgroups are shown in Tables 5 and 6; notable trends are discussed below.

Leukemias

Significant 5-year rate increases were observed in all demographic subgroups for any leukemia and ALL, and in most subgroups for AML, except black children/adolescents, infants, and those ages 5 through 9 years. ALL patients experienced notably higher survival than AML patients. ALL rates were greater for females than males in the first period; however, males experienced a greater increase from 1975 through 1979 to 1995 through 1999 (+31% vs +22% in females), such that the rates were similar by 1995 through 1999 (83% vs 86%). For AML, the increase also occurred earlier in females and the 5-year rates were similar by 1995 through 1999 (47% females vs 43% males). Survival among black children/adolescents with ALL lagged behind 5-year rates in whites in each time period (1995-1999: 75% vs 85%), whereas AML survival among black children/adolescents was more comparable across the 3 cohorts. By the 1990s, peak ALL rates were observed among those ages 1 to 4 years (92%) and 5 to 9 years (84%) and were lowest among older adolescents (59%) and infants (57%); little difference was observed among AML patients across age groups by 1995 through 1999.

Ten-year rates improved significantly in all subgroups for leukemia overall (+16%-21%); for ALL in all subgroups except infants; and for AML in both sexes, white children/adolescents, and children/adolescents ages 10 to 19 years. Ten-year rates in females exceeded those in males in both cohorts for ALL (1985-1994: 77% vs 71%) and AML (43% vs 32%). Ten-year rates in white children/adolescents were greater than those in black children/adolescents for ALL (1985-1994: 74% vs 62%), but were equivalent for AML (39%). Infants experienced the poorest survival for ALL (1985-1994: 37%), whereas 10-year rates peaked among children ages 1 to 4 years (82%). AML 10-year rates ranged from 34%-43% among all age groups.

Lymphomas

For HL, similar 5-year rates were observed in males and females (1995-1999: 96%), among white children/adolescents (97%), and in those ages 10 to 19 years at diagnosis (96%). Black children/adolescents had lower 5-year rates in 1985 through 1989, but by 1995 through 1999 had approached the rates of whites (91%). Ten-year survival rates of ≥88% were observed for those diagnosed in 1985 through 1994 for both sexes, white children/adolescents, and children/adolescents ages 5 to 19 years. Ten-year rates in black children/adolescents were slightly lower (83%).

For NHL, 5-year survival in females was greater than in males diagnosed in 1975 through 1979 (57% vs 42%), but was equivalent in subsequent years (1995-1999: 81%). Substantial improvements in 5-year rates were found in whites, blacks, and among those diagnosed at age ≥1 year. For the 1995 through 1999 cohort, 5-year rates were approximately 80% across racial groups and peak survival rates were observed among those diagnosed at ages 10 to 14 years (87%) and 5 to 9 years (85%). Improvements in 10-year survival were similar to those in 5-year rates. For those diagnosed in 1985 through 1994, 10-year rates were ≥70% for all subgroups except infants (60%) and adolescents (68%); children ages 1 to 4 years achieved the highest 10-year rate (78%).

Central Nervous System Malignancies

Five-year rates of central nervous system (CNS) tumors increased significantly in all subgroups except infants. Five-year rates were slightly higher in females than males (1995-1999: 77% vs 73%) and were higher in whites compared with blacks (77% vs 64%) across the 3 diagnostic periods. Children/adolescents diagnosed at age >9 years had greater 5-year rates (1995-1999: 80%) compared with those diagnosed at younger ages (<1 year: 56%, 1-4 years: 71%, and 5-9 years: 73%). Ten-year rates increased among males, white children/adolescents, and those ages 5 to 19 years. Similar patterns to the 5-year rates were observed by sex and race. Ten-year survival for those diagnosed in 1985 through 1994 increased monotonically with age to reach a maximum among those ages 15 to 19 years (infants: 46%; ages 15-19 years: 71%).

For astrocytoma, 5-year rates in males and females were comparable in the first 2 periods, whereas rates among females were somewhat greater in the 1990s (89% vs 83% in males). Whites had consistently higher 5-year survival rates compared with blacks (1995-1999: 87% vs 75%). Children ages 1 to 4 years had the highest 5-year survival rates (1995-1999: 90%), whereas infants and adolescents ages 15 to 19 years had the lowest rates (80% and 81%, respectively). Substantial increases in 10-year rates were observed for males, females, whites, infants, and those ages 10 to 19 years at diagnosis. Males and females had similar 10-year rates in both cohorts (1985-1994: 76% vs 73%), whereas 10-year rates were lower in black children/adolescents compared with whites (68% vs 75%, respectively). Children ages 1 to 4 years at diagnosis fared the best (1985-1994: 80%), whereas 10-year rates among other age groups were >70% in 1985 through 1994.

For primitive neuroectodermal tumor (PNET), a significant 25% increase in 5-year survival was observed for males between 1975 through 1979 and 1995 through 1999, such that rates in males and females were equivalent in 1995 through 1999 (65% vs 64%). Five-year rates were comparable in white and black children/adolescents in the 3 time periods (1995-1999: 67% vs 63%); a substantial increase was seen among whites during the period of observation (+20%). Children/adolescents ages 10 to 14 years had the highest 5-year survival rates (1995-1999: 81%) and infants had the lowest (28%); significant improvements were observed between 1975 through 1979 and 1995 through 1999 for children/adolescents ages 5 to 14 years. Further analysis revealed a significant improvement in 5-year survival for medulloblastoma over the 25-year period among those ages birth to 19 years (1975-1979: 47% vs 1995-1999: 68%). Ten-year rates increased among males (1975-1984: 40%; 1985-1994: 54%) and those ages 5 to 9 years at diagnosis (1975-1984: 44%; 1985-1994: 63%).

Neuroblastoma

Significant increases in 5-year survival were observed across the 25-year period for males (+16%), females (+9%), white children/adolescents (+14%), infants (+7%), and those ages 1 to 4 years at diagnosis (+24%). For those diagnosed in 1995 through 1999, 5-year rates were similar among males (68%) and females (66%) and across the 2 racial groups examined (67%-68%). Five-year rates in infants were appreciably higher than rates in children diagnosed at ages 1 to 4 years across all 3 cohorts (1995-1999: 93% vs 55%); few cases were diagnosed at older ages. Ten-year survival increased in the groups listed above, with the exception of infants, who experienced the greatest rates in both diagnostic cohorts (83%).

Wilms Tumor

Increases in 5-year survival occurred primarily between the 1975 through 1979 and 1985 through 1989 cohorts and were observed in males (+16%), females (+18%), whites (+16%), and blacks (+28%). Five-year rates were ≥90% for each of these subgroups by the 1990s. Significant increases were also observed over the entire period of observation among children ages birth to 9 years (+15-17%); the highest 5-year rates were observed in infants (1995-1999: 98%). Similarly, males (+13%), females (+10%), whites (+12%), and children ages 1 to 4 years (+12%) experienced significant increases in 10-year rates; rates reached or exceeded 90% in these subgroups.

Osteosarcoma

Noteworthy increases in 5-year survival were observed in males between 1975 through 1979 and 1995 through 1999 (+28%); rates among males and females were comparable in the 1990s (66% vs 63%). Significant 5-year rate increases were observed for white children/adolescents (+24%), and children and adolescents diagnosed at ages 10 to 14 years (+23%). Ten-year survival improved significantly in males (+14%), females (+15%), white children/adolescents (+16%), and adolescents ages 15 to 19 years (+17%). Ten-year rates in females were substantially greater than those in males in both cohorts (1985-1994: 65% vs 55%, respectively).

Ewing Sarcoma

Five-year rates were disparate between males (36%) and females (54%) diagnosed in 1975 through 1979; this gap closed in the intervening time (1995-1999: 68% and 65%, respectively). White children/adolescents (1975-1979: 42% vs 1995-1999: 65%), children/adolescents ages 10 to 14 years (47% vs 74%), and adolescents ages 15 to 19 years (28% vs 53%) also experienced substantial increases. Ten-year rates increased significantly in males, white children/adolescents, and adolescents (1985-1994: 44%, 51%, and 44%, respectively). All rates are based on few cases and should be interpreted cautiously.

Rhabdomyosarcoma

Five-year increases were principally observed between 1975 through 1979 and 1985 through 1989 and were found in males (+18%), whites (+13%), and patients ages 15 to 19 years (+29%). A substantial increase in 5-year survival was also seen between 1975 through 1979 and 1995 through 1999 for those diagnosed at ages 10 to 14 years (+21%). Ten-year rates improved for males (+13%), whites (+10%) and children ages 1 to 4 years (+25%); males (1985-1994: 66%), whites (65%), and children ages 1 to 4 years and 5 to 9 years (86% and 66%, respectively) experienced the highest 10-year survival.

Germ Cell Tumors

For those diagnosed in 1975 through 1979, the 5-year rate in females (78%) was greater than that of males (66%), but by 1995 through 1999 the rates were nearly equivalent (93% vs 91%, respectively). Substantial improvements were observed in white children/adolescents (+23%) and among those ages 1 to 4 years (+27%), 10 to 14 years (+15%), and 15 to 19 years (+22%), such that 5-year rates in the 1995 through 1999 cohort were ≥90% in white children/adolescents and in those ages 1 to 19 years; 5-year rates were 88% in blacks and 86% in infants. Ten-year rates were ≥80% for those diagnosed in 1985 through 1994 for most demographic groups; infants (73%) and children ages 5 to 9 years (77%) experienced lower rates.

Melanoma

Improvements in 5-year survival were observed in males between 1975 through 1979 and 1995 through 1999 (+16%), such that equal rates in males and females were reached in 1995 through 1999 (93%-94%). Increases were also observed in whites (+11%) and in those ages 5 to 9 years (+43%) and 15 to 19 years (+13%); few cases were noted among black children/adolescents and those <10 years old. These improvements were mainly attributable to the interval between 1975 through 1979 and 1985 through 1989. Significant improvements in 10-year survival were observed for females (+9%), whites (+9%), and those ages 15 to 19 years (+12%). The 10-year rate for males diagnosed in 1985 through 1994 (83%) lagged behind that of females (94%) considerably.

Hispanics

Five-year survival among Hispanic children/adolescents diagnosed in 1995 through 1999 was lower than that of non-Hispanic white children/adolescents (74% vs 81%, respectively; Table 4). The greatest difference occurred for Ewing sarcoma (Hispanics: 27% vs non-Hispanic whites: 64%). Five-year rates were also significantly lower among Hispanic children/adolescents for leukemias overall (−9%), ALL (−9%), CNS tumors overall (−11%), astrocytoma (−12%), other gliomas (−25%), and melanoma (−16%). There were no statistically significant differences observed between Hispanic and non-Hispanic black children/adolescents, likely because of insufficient numbers of black cases.

DISCUSSION

  1. Top of page
  2. Abstract
  3. MATERIALS AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES

Substantial increases in 5-year and 10-year survival rates have been observed in the US for pediatric and adolescent cancers overall and for the majority of cancer types and demographic subgroups examined. Similarly, survival data collected on >100,000 children and adolescents ages birth to 19 years via population-based registries throughout Europe showed a 73% 5-year rate for those diagnosed in the 1990s and improved survival across all International Classification of Childhood Cancer (ICCC) categories compared with those diagnosed in the 1970s and 1980s.12

Progress in the treatment of pediatric and adolescent cancers includes improved understanding of the molecular basis of childhood cancers, customized therapies based on patient prognostic characteristics and tumor biology, and multimodal and combination therapies.12–14 A prime example is the improved ALL survival attributable to the introduction of risk-based therapies, which account for leukemic subtype and individual patient characteristics.14, 15 The development and application of similar methods is predicted to have a dramatic impact on AML outcomes.16 Improvements in CNS cancer survival are attributable to better diagnosis via enhanced imaging techniques, and advancements in neurosurgery and therapeutic radiation, in combination with conventional chemotherapy.17 Advances have also been made in rare tumors.18

Observed increases can be attributed in large part to advances in therapeutic interventions developed by cooperative clinical trials groups, such as the Children's Oncology Group (COG).19 Greater than 200 COG institutions treat an estimated 71% to 94% of cancer patients ages birth through 14 years in North America.20, 21 The phase 3 randomized trials conducted by COG and other cooperative networks allows the safety and efficacy of novel therapeutic modalities to be investigated in reference to standard treatments on a larger scale than would otherwise be feasible. Oversight of these studies permits gatekeeping, such that successful therapies are retained and those deemed ineffective or harmful are abandoned, ultimately leading to better outcomes for affected patient populations.13

Differential survival was observed in infants compared with other age groups with respect to ALL, CNS tumors, neuroblastoma, Wilms tumor, and hepatoblastoma; significant increases were detected in each of these, with the exception of CNS tumors. Factors impacting disease severity and prognosis are distributed differently in infants, including the higher prevalence of MLL rearrangements associated with reduced survival among infant leukemia cases14 and higher prevalence of hyperdiploidy, and lower prevalence of MYCN amplification, loss of heterozygosity at 1p, and trisomy of 17q associated with higher survival of infant neuroblastoma.15 Infants' tolerance of and sensitivity to therapeutic agents differs from that of older children, and infants are at increased risk fortreatment-related morbidity and mortality.16 For example, infant ALL patients have demonstrated a poor response to conventional chemotherapeutic agents, leading to the investigation of alternate therapies, such as cytarabine and FLT-3 inhibitors.16 Furthermore, there is a strong aversion to the use of radiation therapy in treating infant CNS tumors because of concerns regarding adverse neuropsychologic effects.17

Although adolescents ages 15 to 19 years experienced the greatest overall survival compared with their younger counterparts, they had notably lower 5-year rates for ALL, NHL, Ewing sarcoma, and rhabdomyosarcoma. Importantly, increases were observed in each of these cancers between 1975 through 1979 and 1995 through 1999, except for rhabdomyosarcoma. At least 3 factors contribute to lower adolescent rates. The principle factor is that adolescent malignancies differ from those in younger cases on important biological prognostic factors. For example, favorable attributes of ALL, such as hyperdiploidy and TEL-AML1 translocations, occur primarily in children diagnosed at ages 1 to 9 years,3 whereas unfavorable characteristics, such as L2 morphology, pro-T-cell immunophenotype, and the BCR-ABL translocation, are more common among adolescents.18 For NHL, adolescents are more likely to be diagnosed with diffuse large B-cell lymphomas, including primary mediastinal B-cell lymphomas, and other rare histologies than younger patients,3, 22 which are associated with lower survival rates.22 Similarly, the proportion of cases with alveolar rhabdomyosarcoma, associated with poorer survival compared with embryonal rhabdomyosarcoma, is greater among adolescents.23 Second, there is a delay in cancer detection among this group because of psychologic, social, and economic factors.24 Third, adolescents with cancers commonly found in younger children have better outcomes when treated on pediatric therapeutic protocols24; however, a minority of adolescent patients have historically participated in pediatric or adult cooperative group trials, irrespective of race or ethnicity.21, 25 Initiatives are currently underway to address this inequity.24

Sizable discrepancies in 5-year survival between males and females diagnosed in the 1970s largely disappeared by the 1990s, except possibly in astrocytoma, whereas sex differences in 10-year survival overall and for ALL, AML, PNET, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, and melanoma were observed in the 1985 through 1994 cohort. These 10-year rates should be monitored to ensure that the gaps narrow.

Differences between white and black children/adolescents were noted overall and for ALL, CNS tumors (astrocytoma), and osteosarcoma. Disparities across racial groups must be interpreted with caution, because there were relatively few cases in black children/adolescents, particularly rare tumors. Racial and ethnic differences in survival may reflect differential access to healthcare along socioeconomic boundaries; however, this assumption should be investigated further. The registration rates reported within COG are fairly consistent across white and black racial groups (58%-59%).21 Nevertheless, several ALL studies have reported poorer outcomes for black children with standard risk and fewer studies showed evidence of poorer survival among Hispanics with high-risk characteristics.26 With respect to other cancers, a single-center study reported no difference in 10-year survival rates for black versus white children overall and for most cancer types, with the exception of osteosarcoma, in the modern treatment era.27 Other possible explanations for disparities include racial/ethnic differences in protocol adherence or drug metabolism,26 delayed detection, or less favorable tumor characteristics.

There were significant differences in survival among Hispanic children/adolescents compared with non-Hispanic whites. The large disparity in Ewing sarcoma survival, although statistically significant, was based on few Hispanic cases; survival rates should be monitored to see whether this pattern continues. Greater leukemia incidence rates have been observed in Hispanics compared with non-Hispanic whites,28 poorer survival for ALL has been reported among Hispanics with high-risk characteristics,26 and a recent cytogenetics study of childhood ALL revealed fewer TEL-AML1 translocations among Hispanic children.29 This evidence suggests a different etiology, and perhaps severity, of leukemia. We speculate that 5-year survival rates may be lower among Hispanic children/adolescents for astrocytomas and other gliomas because of a lag in access to improved diagnostic methods, such as magnetic resonance imaging and computerized topography technologies, analogous to the period before 1984 in other sectors of the population.30 Detection of melanomas among Hispanic children/adolescents may be delayed because of a lack of perceived susceptibility.31 Of note, Hispanic children/adolescents are registered with COG at a rate slightly below that of non-Hispanic white and black children/adolescents (54%).15 These results underscore a need for attention to this growing subset of the US population.

The present analysis provides a comprehensive update of US pediatric cancer survival statistics. The chief strength in using SEER data is the high rate of case ascertainment from a large portion of the US. However, SEER is not a national registry, and important demographic and/or etiologic differences between the 9% and 14% of the population monitored by the SEER 9 and 13 registries, respectively, and the 91% and 86% not under surveillance could occur by chance.32 Follow-up for vital status on pediatric and adolescent patients is more difficult than for adult cancer patients, as children eventually leave their parents' homes and some change their names, resulting in approximately 14% lost to follow-up.3 SEER race classification has shown excellent agreement with self-report; however, SEER tends to slightly overclassify individuals as Hispanic.33 Such misclassification may underestimate differences in survival between Hispanics and non-Hispanics. Furthermore, molecular classification may be more informative for evaluating rates in rare subgroups (eg, MLL rearrangements), yet this information is not available in SEER. Minor changes in classification34 or detection may have influenced survival trends. In addition, our trend analysis did not allow for joinpoints (ie, points at which the slope of the regression line changes in magnitude or direction). Allowing joinpoints may reveal changes in trends, such as plateaus in rates in the 1990s that can be concluded from visual inspection of Figure 1. This is addressed in part by the comparison of rates between 1985 through 1989 and 1995 through 1999 shown in Table 1, wherein statistically significant differences were observed for the most prevalent cancers. Finally, minor random fluctuations may erroneously demonstrate noteworthy trends.

The results of the current study confirm that survival rates for many pediatric and adolescent cancers have increased over time. Enhancements in survival have produced an expanding population of survivors at risk for adverse physical/psychosocial effects and in need of long-term care.35 Future efforts should focus on therapeutic advances, elimination of disparities among minorities and adolescents, and care of survivors.

REFERENCES

  1. Top of page
  2. Abstract
  3. MATERIALS AND METHODS
  4. RESULTS
  5. DISCUSSION
  6. REFERENCES