Progress towards the WHO Global Initiative for Childhood Cancer target of 60% 5-year survival for all childhood cancers combined, 1990–2019 (CONCORD-4): a Cancer Survival Index derived for 68 countries by analysis of individual records for 613 021 ch

<h2>Summary</h2><h3>Background</h3> CONCORD is a global public health programme for long-term surveillance of population-based cancer survival. The first three cycles of this programme focused primarily on adults. In CONCORD-4, for the first time, we also included all cancers in children. The WHO Global Initiative for Childhood Cancer (GICC), published in 2018, set a target for 5-year survival for all childhood cancers combined, worldwide, to reach 60% by 2030. We designed the protocol for CONCORD-4 to assess progress towards this target in as many countries as possible. <h3>Methods</h3> We identified population-based cancer registries from the members of the International Association of Cancer Registries and other sources. We invited 513 registries in 101 countries to submit anonymised individual records for all children (aged 0–14 years) living in their territory who were diagnosed with any form of cancer during the 30-year period 1990–2019, or later years. The data included demographic variables, the morphological type and anatomical location of the tumour, and the follow-up for the vital status of each child. We used the data for 2010–19 to construct a set of weights that reflect the global frequency distribution of childhood cancers, by age, sex, and subtype, both for the 12 major groups in the third edition of the International Classification of Childhood Cancer (ICCC-3) and for the six WHO tracer cancers prioritised in the GICC. We estimated 5-year net survival for children diagnosed during 1990–2019 by age, sex, and type of cancer, using the Pohar Perme estimator. We then used the weights to construct a Cancer Survival Index (CSI) as a weighted average of these survival estimates, for each country and each 5-year period during 1990–2019 for the 12 ICCC-3 groups and separately for the six WHO tracer cancers. <h3>Findings</h3> We received 679 776 individual records for children diagnosed with cancer during 1990–2022 from 307 population-based cancer registries in 68 countries and territories, 52 with 100% national coverage. We produced two sets of weights, by age, sex, and type of cancer, reflecting the global distribution of cancer in children, both for all childhood cancers and for the six WHO tracer cancers. We restricted survival analyses to 613 021 children diagnosed during 1990–2019. The 5-year CSI for all childhood cancers combined increased in most countries between 1990 and 2019. For children diagnosed during 2015–19, the CSI was more than 80% in most high-income countries, in the range 60–80% in most upper-middle-income countries, and in the range 50–60% in the five participating lower-middle-income countries. <h3>Interpretation</h3> The new CSI enables quantitative international comparison of trends in survival for all childhood cancers combined and for the six WHO tracer cancers, through a simple three-way standardisation by age, sex and subtype. The CSI should be a useful tool to monitor future trends. In most high-income, upper-middle-income, and lower-middle-income countries participating in CONCORD-4, the all-cancers CSI was either close to or had already passed the GICC target to reach 60% 5-year survival for all childhood cancers combined, worldwide, by 2030. The GICC target therefore may not be ambitious enough. <h3>Funding</h3> Cancer Research UK, Institut National du Cancer (France), St Jude Children's Research Hospital (USA), US National Cancer Institute, and Dell Technologies.

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Journal
The Lancet
Published
2026-03-01
DOI
https://doi.org/10.1016/s0140-6736(26)00189-3
Primary Topic
Acute Lymphoblastic Leukemia research
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article
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article

Progress towards the WHO Global Initiative for Childhood Cancer target of 60% 5-year survival for all childhood cancers combined, 1990–2019 (CONCORD-4): a Cancer Survival Index derived for 68 countries by analysis of individual records for 613 021 ch

Antoinette M. Stroup, Morgan M. Millar, Cristiane Bastos Daniel, Laura Steponavičienė et al.
The Lancet
Acute Lymphoblastic Leukemia research
article

Progress towards the WHO Global Initiative for Childhood Cancer target of 60% 5-year survival for all childhood cancers combined, 1990–2019 (CONCORD-4): a Cancer Survival Index derived for 68 countries by analysis of individual records for 613 021 ch

Antoinette M. Stroup, Morgan M. Millar, Cristiane Bastos Daniel, Laura Steponavičienė, Sumitha Nagarajan, Gianfranco Cossani, Joseph Grandpre, L. V. Pikalova, Masashi Matsuzaka, R J Chillarón, Donsuk Pongnikorn, Enrica Santelli, Jacqueline Deloumeaux, Jonathan Simkin, Margit Mägi, Petra Ihle, Adela Cañete-Nieto, Emmanuel Chirpaz, Volker Arndt, A Türkköylü, S Chiodini, Bruna S. Ragaini, Lyn Almon, Erdenekhuu Nansalmaa, Jessica Roydhouse, Pilar Gutiérrez Meléndez, Yoshitaka Hippo, H. Kajueter, Fortunato Bianconi, Benjamin Leo, Carina Musetti, Seiki Kanemura, Norihiro Teramoto, Jessica Link Reeve, Gianfranco Manneschi, M A Chaplin, Sandra Lucía Suárez Delgado, N. Boussouf, F Tobori, Roberto de Almeida Gil, Hiroshi Kumagai, S. Bouzbid, Lucia Bisceglia, Eiman Alawadhi, Kaname Watanabe, Amy Johnston, M Rognoni, Chun‐Ju Chiang, Richard Knowlton, Martina Taborelli, Stephanie Smits, Daniela Ramirez Aguilar, Isao Miyashiro, Nicolás Luciano Campoverde Arévalo, Sarah Dugdale, Y Cavusoglu, Ainur Aiypkhanova, Mario Šekerija, Fabio Savoia, Alexandra Neaga, Bożena M Morawski, Antonella Puppo, Rana Bayakly, Carolina Goic, Luc te Marvelde, Alfreda Woods, Alessandra Ravaioli, William Mantovani, Mary E. Charlton, F E Karaşahin, Atit Leklob, H Sundseth, Masaaki Kobayashi, Enrica Migliore, Tatiana Lizarazo Balcárcel, Claudia Casella, Pamela Minicozzi, Naomi Ssenyonga, Mihaela Bucurenci, Berenice Rodríguez-Zea, A Ladipo, Mathieu Nacher, Fumitaka Moki, Michiko Naito, N Üçüncü, José Carlos Oliveira, Karolina Sikorska, Hidemi Ito, Urszula Wojciechowska, T Freeman, Mei‐Chin Hsieh, Julyanti Agustina, Narue Nakabayashi, Aya Kinjo, SokKing Ong, Fernando Almela, Nobuaki Michihata, Tabassum Z. Insaf, Christine Fowler, D. B Veneziano, Suzanne Bentler, Mirka Smith, Sandi L. Pruitt, K Iwasa, Wendy Aldinger, Francesco Vitale, Nelson Enrique Arias-Ortiz, Margaret Grayson, Hülya KARAKILINÇ, Kinan Drak Alsibai, Claudia Uribe, Lisa Paddock, Ryan Woods, Carolyn Bancroft, Leyda Elizabeth Jaramillo Feijoo, Duygu Özhan Turhan, Clàudia Garrido, Daniela Piras, Rosalia Ragusa, Sheila K. Kristensen, C. Camacho, Lorraine Shack, Masayoshi Yoshida, Giedrė Smailytė, Barbara Silverman, Natalia Sanz, Sarayut Lucien Geater, Solange Melina Gómez Vargas, Liesbet Van Eycken, Hans H. Storm, Kevin C. Ward, V Di Carlo, K. Henau, Sue Evans, Jeff Dowden, Elizabeth Chalker, Donna Turner, Clarisse Joachim, J Castillo, Paweł Macek, Alexandra Giraldo-Osorio, Mona Highsmith, Yuriko N. Koyanagi, Chalongpon Santong, Maciej Trojanowski, Ebert Poquioma, Adriana M. Torres, Yoneatsu Osaki, Junhie Oh, Urszula Sulkowska, Michael R. Flaherty, Eva Ardanáz, Márcia Cristina de Sousa Reis, David Morrison, Kimberly A. Herget, Rebeca Rivera Gómez, Puttachart Maneesai, Undarmaa Tudev, Daphne Y. Lichtensztajn, Keisha L Musonda, Wenqiang Wei, Siri Larønningen, C. Laporte, Natsumi Yamashita, K G Aird, Junichi Nakashima, Ilaria Cozzi, Jonathan Macni, Olufemi Ogunbiyi, M B Keitheri Cheteri, Gülsen Aksoy, Karnchana Daoprasert, Sandy Kwong, Steven E. Blankenship, Karen R Mead, Martin Whiteside, Iris Zachary, Marina Borisevich, Claude Alcaraz, Güledal Boztaş, Mikhail Yuryevich Valkov, Baozhen Qiao, Carlos Anselmo Lima, Rosa M. Avila, S Sangkitipaiboon, Paola Ballotari, Sabine Siesling, María Dolores Chirlaque López, Nkese Felix, C. Ochir, Trayan Atanasov, Reda Wilson, Z. Valerianova, Patti Migliore Santiago, Mingshi Cai, Y H Galán Alvarez, Shoni Philpot, Angela Eckstrand, Charles Stiller, Gordon Walsh, Claire Poulalhon, J. Chaves, Wanqing Chen, Y Nemoto, Wilhelmina Ross, M Matz, K Kurosawa, Arantza López-de-Munain, Hiromi Sugiyama, A Maurina, M.M. El Mistiri, Lou Gonsalves, Bezawit E. Kase, Neville Calleja, Ekaterina Nazarova, T Beran, A Elbasmi, Meg McKinley, R M Slocumb, Cyllene R. Morris, Jennifer Kachajian, Lori Koch, Georgetta Alverson, Adele Caldarella, Camilla Calì, Miroslav Zvolský, Aundrea Ogushi, María-Isabel Palacios-Castaño, M Motnyk, Eun Hye Park, Keiichi YOSHIDA, Catarina Rodrigues, Giuseppe Sampietro, Giuseppe Cascone, David Parra, T. C. Tucker, Marcel Blum, Gregory P. Doyle, Gijs Geleijnse, Massimo Melis, Anshu Shrestha, Chanavee Toh, Lihua Liu, Maria José Bento, Luca Cavalieri d'Oro, G. Forjaz de Lacerda, Marise Souto Rebelo, Monika Hackl, Claudia Allemani, Maria Gentilini, Kamila Kępska, Grit Sommer, Chie Ono, A Sánchez Gil, Georgia Yee, Prithwish De, Tomasz Mierzwa, Angela W. Meisner, Desy Khairina, Judith R Rees, T A Janes, Silke Hermann, Rina Tanaka, Cankut Yakut, Whitney Hammond, Anna Demetriou, Merve Altinisik, M. Perez, Andreas Stang, Antonio Lourenço, M Hamdi-Chérif, Masako Satô, Rufino Álamo Sanz, Maria Francesca Vitale, Kayo Nakata, Deirdre Fitzpatrick, Norimasa Fukushima, Tina Žagar, Yasuharu Kaizaki, D Lemons, Pasquala Pinna, Patricia Cerda, Ana Vizcaíno, Konstantine Kazanjan, Izumi Oki, Tamara Weaver, D.A. Herrmann, J.R. Espinoza, Deirdre Rogers, Mayuko Yoshitake, H J Zimmerman, Fatima Khan Baloch, Sonia Manasse, Kern Rocke, Carla Espinoza-Vallejos, Soad Fuentes-Alabi, Carlos R Torres-Cintrón, Kyu-won Jung, Elvynna Leong, Katerina Dadouli, Fabiana Lima Vazquez, Florencia Moreno, Kelly Gianina Núñez, Tracey A. O'Brien, Massimo Vicentini, Santa Valenti Clemente, Rocco Galasso, Giuseppa Candela, Mohsen Mousavi, Matthias Lorez, John Broggio, Maria Theresa Redaniel, Nathalie Saint-Jacques, Carlos Rodriguez-Galindo, Wen-Chung Lee, Jay Desai, Charles Wiggins, Anna Gos, Jan Trallero, Antonio G Russo, Julie Ruterbusch, S. Christina Oancea, Søren Friis, Julie Moore, Meagan Carter, Fatma Simsek, Daisuke Mori, Hiroto Narimatsu, Fabio Falcini, Juan González, Zane Baltane, Federica Manzoni, Rowena Boyd, Patricia Perez, Zsuzsanna Jakab, Chris Lewis, Manuel Zorzi, Bernard Bhakkan, Jaume Galceran, Dyfed W Huws, Gulnar Azevedo e Silva, Jhony Joe Real Cotto, Eugenia Spata, Mary Harney, Sue-Min Lai, Rosario Tumino, Peter Workman, Gil PM Pena, Alexandra Mayer-da-Silva, Karen Handley, Takashi Oda, Monica L Carranza Mena, Marta De-La-Cruz, Fabrizio Stracci, Derya Bagci, Makiko Nishimura, Marisa K Sophiea, Bin Zhang, Al Hareth M Al Khater, Alvaro L Montiel, Pedro Berenguer, Wilmer Tarupi, Juliana Nativio, Belgin Kurnali, Amy MM Yamamoto, Kaire Innos, Richard Stephens, Montserrat Garrido, Nuria Aragonés, Dana Doyle, Nilüfer Karagöz, Mark Watson, Nickhill H Bhakta, Lindsay M Collins, Eshwar Kumar, Claudia M Hormiga Sánchez, Xiao-Cheng Wu, Sarah Jeffrey, Joanne Aitken, Fabio Girardi, Todd A Norwood, Lamia Kara, Sheila Fukumura, Prashant Mathur, Antonina Torrisi, Shin Fujita, Anna Patro, Karen J Ortiz-Ortiz, Brenda Y Hernandez, Tomohiro Matsuda, Fabio Vittadello, Herbert CS Barros, Walter Mazzucco, Milena M Maule, Alla Egorova, Luigino Dal Maso, Ayse Kahraman, Chandrika Rao, Anny Gomez, Hui You, Justyna Nieweglowska, Gary M Levin, Valerie Somma, Michael Mian, Armando D Cortés Buelvas, Kenji Tamura, Paulo César F De Souza, Stephen M Schwartz, Walmiro Ferreira Ramos Neto, Justin T George, Erica Giacomazzi, Rafael Alonso, Brenda EB da Silva, Natasha P Sobers, Sultan Eser, Tiziana Scuderi, Michel P Coleman, Emily Prince-Joseph, Rossella Abbate, Bernd Holleczek, Enrique Ramalle-Gómara, Harold M Casas Cruz, Magna S Alexandre-Moreira, Andrey Orlov, Rani Reed, Deirdre E Murray, Heather M Armstrong, Daniel Redondo-Sanchez, Mushabbab A Al Asiri, Luisa M Bravo Goyes, Karine Meireles do Valle, Yuji Koduka, Masakazu Hattori, Nontuthuzelo IM Somdyala, Ana Isabel Marcos M Navarro, Ana Pais, Sarah Quesnel-Crooks, Marco Pompili, Natalie B Rath, Carol A McClure, Hamza Çakan, Joanna A Didkowska, Miklos Garami, Taylor Eisele, Akiko Shibata, Angela Mariotto, David J Lee, Laci Davis, Nobuki Todo, Simon M Kønig, Agnieszka Rosinska, Soumaya Amarouche, Pau Alfonso-Camos, Zofia Kolodziejczyk, Consol Sabater, Lena C Swander, Pero Ivanko, Karen AM Phillips, Brigitte Lacour, João Macedo, Chieko Kawamura, Francesca Bella, Tatyana Savich, Elvia Karina Grillo Ardila, Danuta Owsiak, Frederik Peters, Katarzyna Barna, Maria Jose Orbe Muñoz, Sarma Garimella, Damien Bennett, Francesco Cuccaro, Alojz Peterle, Ling Li Foo, Lital Keinan-Boker, Paul Dickman, Eric B Durbin, Christian R Garcia, Jaunita L Conaway, Mary Elizabeth O'Neil, Miriam J Azzopardi, María Paz Sandoval, Jan Mužík, Jennifer H Hayes, Claudia E Kuehni, Ivan Rashid, John Arend, Franco Cavalli, Bin Huang, Chirapong Harnprakopsuk, Greig Stanner, Christopher J Johnson, Saime Nilgün Keloglu, Okan Ceylan, Vesna Zadnik, Lilia D Zhuikova, Ann G Schwartz, Marta Sbaraglia, Emily Bunt, Serena Kozie, Tulin Gurbuz, Federico Gervasi, Sarah Stevens, Katharina Stähelin, Tom B Johannesen, Judy R Rees, Marià Carulla, Joana Oliveira, Claudia LA Veneziano, Yun Zheng, Stephanie Flak, Satoru Maruyama, Marcela Guevara, Leticia M Fernández Garrote, Mario Usala, Karen Rosas, Luis E Medina Fernández, Edyta Garbowska, Dmitry V Bogdanov, Rabia Çidan, Malgorzata Meina, Annemarie Schultz, Rafael Marcos-Gragera, Hannah K Weir, Eman Alkhalawi, Julie Cleaton
article en

Abstract

<h2>Summary</h2><h3>Background</h3> CONCORD is a global public health programme for long-term surveillance of population-based cancer survival. The first three cycles of this programme focused primarily on adults. In CONCORD-4, for the first time, we also included all cancers in children. The WHO Global Initiative for Childhood Cancer (GICC), published in 2018, set a target for 5-year survival for all childhood cancers combined, worldwide, to reach 60% by 2030. We designed the protocol for CONCORD-4 to assess progress towards this target in as many countries as possible. <h3>Methods</h3> We identified population-based cancer registries from the members of the International Association of Cancer Registries and other sources. We invited 513 registries in 101 countries to submit anonymised individual records for all children (aged 0–14 years) living in their territory who were diagnosed with any form of cancer during the 30-year period 1990–2019, or later years. The data included demographic variables, the morphological type and anatomical location of the tumour, and the follow-up for the vital status of each child. We used the data for 2010–19 to construct a set of weights that reflect the global frequency distribution of childhood cancers, by age, sex, and subtype, both for the 12 major groups in the third edition of the International Classification of Childhood Cancer (ICCC-3) and for the six WHO tracer cancers prioritised in the GICC. We estimated 5-year net survival for children diagnosed during 1990–2019 by age, sex, and type of cancer, using the Pohar Perme estimator. We then used the weights to construct a Cancer Survival Index (CSI) as a weighted average of these survival estimates, for each country and each 5-year period during 1990–2019 for the 12 ICCC-3 groups and separately for the six WHO tracer cancers. <h3>Findings</h3> We received 679 776 individual records for children diagnosed with cancer during 1990–2022 from 307 population-based cancer registries in 68 countries and territories, 52 with 100% national coverage. We produced two sets of weights, by age, sex, and type of cancer, reflecting the global distribution of cancer in children, both for all childhood cancers and for the six WHO tracer cancers. We restricted survival analyses to 613 021 children diagnosed during 1990–2019. The 5-year CSI for all childhood cancers combined increased in most countries between 1990 and 2019. For children diagnosed during 2015–19, the CSI was more than 80% in most high-income countries, in the range 60–80% in most upper-middle-income countries, and in the range 50–60% in the five participating lower-middle-income countries. <h3>Interpretation</h3> The new CSI enables quantitative international comparison of trends in survival for all childhood cancers combined and for the six WHO tracer cancers, through a simple three-way standardisation by age, sex and subtype. The CSI should be a useful tool to monitor future trends. In most high-income, upper-middle-income, and lower-middle-income countries participating in CONCORD-4, the all-cancers CSI was either close to or had already passed the GICC target to reach 60% 5-year survival for all childhood cancers combined, worldwide, by 2030. The GICC target therefore may not be ambitious enough. <h3>Funding</h3> Cancer Research UK, Institut National du Cancer (France), St Jude Children's Research Hospital (USA), US National Cancer Institute, and Dell Technologies.

The Lancet
National Health Service (GB), University College London Hospitals NHS Foundation Trust (GB), Universitat de València (ES), Pontificia Universidad Católica de Chile (CL), University of Zagreb (HR), Radiation Effects Research Foundation (JP), Chinese Academy of Science South America Center for Astronomy (CL), London Cancer (GB), London School of Hygiene & Tropical Medicine (GB), Hrvatski zavod za javno zdravstvo (HR), Istituto Oncologico Veneto (IT), National Cancer Registry (IE), Policlinico Universitario di Catania (IT), Institute of Social and Preventive Medicine (CH), Andrija Stampar Teaching Institute of Public Health (HR), Hospital Universitari Sant Joan de Reus (ES), National Cancer Registration Service (GB), University College London (GB)
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Acute Lymphoblastic Leukemia research
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