Analysis of Causes and Risk Factors for Deaths Among Pediatric Oncology Patients: A 20-Year Observation

Background: Despite major therapeutic advances, mortality among children with cancer remains a significant clinical problem, particularly treatment-related mortality (TRM). The aim of this study was to analyze causes of death and identify mortality risk factors in pediatric oncology patients. Material and Methods: A retrospective single-center study was conducted in patients hospitalized for oncological diseases between 2004 and 2024. Seventy deceased patients were identified. A matched control group of survivors (n=70), adjusted for sex, age, and diagnosis, was included. Demographic, clinical, and laboratory data were analyzed using univariate and multivariate logistic regression. Results: During the study period, 70 children died in hospital. Most were boys (61.4%), with a median age of 130 months. Hematological malignancies accounted for 64.3% of diagnoses. The leading cause of death was disease progression (69.6%), followed by TRM (31.4%), including infection-related mortality (IRM). Independent predictors of death were older age (OR=1.083, 95% CI: 1.006-1.166) and lower platelet count at diagnosis (OR=0.623, 95% CI: 0.456-0.851). Post-hematopoietic stem cell transplantation (HSCT) status was an independent predictor of infectious death (OR=4.04, 95% CI: 1.04-15.61). Conclusion: Mortality in pediatric oncology remains clinically relevant, with a substantial proportion attributable to potentially preventable treatment-related causes. Early risk stratification and intensified supportive care are particularly important in older patients, those with thrombocytopenia, and post-HSCT patients.