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  • Biying Liu,
  • Natasha Abraham,
  • Inam Chitsike,
  • line couitchere,
  • Joyce Balagadde-Kambugu,
  • Nsimba Makouanzi Alda Stévy,
  • Lorna Renner,
  • Donald Maxwell Parkin
Biying Liu
African Cancer Registry Network

Corresponding Author:[email protected]

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Natasha Abraham
National Health Laboratory Service
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Inam Chitsike
University of Zimbabwe
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line couitchere
Centre Hospitalier Universitaire de Treichville
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Joyce Balagadde-Kambugu
Makerere University Hospital
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Nsimba Makouanzi Alda Stévy
General Hospital Adolphe Sicé Pointe Noire
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Universite de Yaounde I Faculte de Medecine et des Sciences Biomedicales
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Lorna Renner
Korle Bu Teaching Hospital
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Donald Maxwell Parkin
University of Oxford Nuffield Department of Population Health
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Background/Purpose Stage at diagnosis is an important metric in treatment and prognosis of cancer, and also in planning and evaluation of cancer control. In sub-Saharan Africa (SSA), for the latter, the only data source is the population-based cancer registry (PBCR). For childhood cancers, the “Toronto Staging Guidelines” have been developed to facilitate abstraction of stage by cancer registry personnel. Although the feasibility of staging using this system has been shown, there is limited information on the accuracy of staging. Methods A panel of case records of 6 common childhood cancers was established. 51 cancer registrars from 20 SSA countries staged these records, using Tier 1 of the Toronto guidelines. The stage that they assigned was compared with that decided by two expert clinicians. Results The registrars assigned the correct stage for 53-83% of cases (71% overall), with the lowest values for acute lymphocytic leukaemia (ALL), retinoblastoma and non Hodgkin lymphoma (NHL), and the highest for osteosarcoma (81%) and Wilms tumour (83%). For ALL and NHL, many unstageable cases were mis-staged, probably due to confusion over the rules for dealing with missing data; for the cases with adequate information, accuracy was 72-73%. Some confusion was observed over the precise definition of three stage levels of retinoblastomas. Conclusions A single training in staging resulted in an accuracy, for solid tumours, that was not much inferior to what has been observed in high income settings. Nevertheless, some lessons were learned on how to improve both the guidelines, and the training course.
09 Mar 2023Submitted to Pediatric Blood & Cancer
09 Mar 2023Submission Checks Completed
09 Mar 2023Assigned to Editor
09 Mar 2023Review(s) Completed, Editorial Evaluation Pending
13 Mar 2023Reviewer(s) Assigned
10 Apr 2023Editorial Decision: Revise Minor
12 Jun 2023Submission Checks Completed
12 Jun 2023Assigned to Editor
12 Jun 20231st Revision Received
12 Jun 2023Review(s) Completed, Editorial Evaluation Pending
12 Jun 2023Reviewer(s) Assigned
28 Jun 2023Editorial Decision: Accept