Pediatric cancers in Tunisia: Epidemiology, clinical characteristics and survival outcomes from a 10-year single-center experience.
This 10-year retrospective study of 563 children treated at a Tunisian pediatric oncology center reports 69% five-year net survival and identifies leukemia, metastatic disease, relapse, and greater distance from the center as adverse prognostic factors.
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This 10-year retrospective study of 563 children treated at a Tunisian pediatric oncology center reports 69% five-year net survival and identifies leukemia, metastatic disease, relapse, and greater distance from the center as adverse prognostic factors.
Research significance
The study provides observational evidence that geographic distance is associated with poorer survival; it supports—but does not test—the hypothesis that decentralizing oncology services, improving referral and transport, and promoting earlier diagnosis could improve pediatric cancer outcomes in resource-limited settings.
Source abstract
BACKGROUND AND AIMS: Pediatric cancers represent a major public health challenge, particularly in low- and middle-income countries (LMICs). This study aimed to describe the epidemiological and clinical characteristics of pediatric cancers managed at a reference center in Tunisia, analyze treatment pathways, and identify prognostic factors associated with net survival. METHODS: A retrospective, single-center, observational prognostic study was conducted at the Pediatric Oncology Unit (POU) of Béchir Hamza Children's Hospital of Tunis over ten years (January 2012 - December 2021), in accordance with STROBE guidelines. All children diagnosed with cancer before age 16 years were included. RESULTS: A total of 563 children were included (sex ratio 1.18). Mean age at diagnosis was 4.3 ± 3.8 years (median: 3.0 years). Solid tumors predominated (81%), led by neuroblastoma (23.6%), renal tumors (17.2%), and retinoblastoma (10.7%). Five-year net survival was 69%. Multivariate Cox regression identified four independent prognostic factors: leukemia (HR=3.33, 95% CI: 2.07-5.35, p<0.001), metastatic disease (HR=2.65, 95% CI: 1.92-3.66, p<0.001), relapse (HR=2.74, 95% CI: 1.96-3.82, p<0.001), and residence >100 km from the POU (HR=1.32, 95% CI: 0.97-1.80, p=0.018). CONCLUSIONS: Satisfactory survival outcomes are achievable in resource-limited settings with a well-structured oncology unit. Reducing geographic barriers to care and strengthening early diagnosis remain key priorities to further improve outcomes.