National Benchmarking of Childhood Cancer Survival by Stage at Diagnosis in Italy (BENCHISTA-ITA): Study Protocol

BACKGROUND: survival rates for childhood cancers have significantly improved over recent decades, with 5-year survival now approaching 90% for many types. However, documented variations in survival across European countries and Italian regions highlight the need to address inequalities. One of the most critical prognostic factors is the extent of tumour spread at diagnosis (tumour stage). OBJECTIVES: the BENCHISTA-ITA aims to enhance understanding of regional differences in childhood cancer survival and to promote the widespread adoption of the Toronto Guidelines (TG) by Italian cancer registries for the most common solid paediatric tumours. DESIGN: the study will examine stage distribution and survival for nine solid paediatric cancers: medulloblastoma, neuroblastoma, Wilms tumour, retinoblastoma, and ependymoma (age: 0-14 years), as well as astrocytoma, osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma (age: 0-19 years). SETTING AND PARTICIPANTS: the study will include all children under 15 or 20 years (depending on the tumour type) diagnosed between 01.01.2013 and 31.12.2017, with relevant histological codes. Participating Italian cancer registries will assign tumour stage at diagnosis using the Toronto Guidelines. STATISTICAL ANALYSIS: the statistical power to detect differences in stage distribution and survival rates among regions is limited by the number of incident cases per tumour type and region. Therefore, analyses will be descriptive, with 95% confidence intervals. Overall survival for each tumour type will be estimated using the Kaplan-Meier method. CONCLUSIONS: BENCHISTA-ITA represents an important step toward a more complete and standardized registration of childhood cancers in Italy. The results may support targeted interventions to reduce inequalities and improve outcomes for paediatric patients.