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 children from 307 population-based cancer registries

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BACKGROUND: 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. METHODS: 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. FINDINGS: 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. INTERPRETATION: 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. FUNDING: 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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