Pediatric cancers in Tunisia: Epidemiology, clinical characteristics and survival outcomes from a 10-year single-center experience

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Published May 24, 2026
https://doi.org/10.62438/tunismed.v104i05.6685
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Vol. 104 No. 05 (2026): Tunis Med May 2026

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Faten Fedhila Ben Ayed
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Ranim Zairi
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Mansouri Mohamed Amine
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Sarra Ben Ahmed
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Rim Amdouni
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Elhem Jbebli
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Raoui Farhat
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Samir Haddad
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Samar Rhayem
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia
Monia Khemiri
Paediatrics Department A, Bechir Hamza Children’s Hospital, Tunis, Faculty of Medicine of Tunis , University of Tunis El Manar, 1007, Tunis, Tunisia

Abstract

Background and aims: Pediatric cancers represent a major public health challenge, particularly in low- and middle-income countries (LMICs). This study aimed to describe the epidemiological and clinical characteristics of pediatric cancers managed at a reference center in Tunisia, analyze treatment pathways, and identify prognostic factors associated with net survival.
Methods: A retrospective, single-center, observational prognostic study was conducted at the Pediatric Oncology Unit (POU) of Béchir Hamza Children's Hospital of Tunis over ten years (January 2012 – December 2021), in accordance with STROBE guidelines. All children diagnosed with cancer before age 16 years were included.
Results: A total of 563 children were included (sex ratio 1.18). Mean age at diagnosis was 4.3 ± 3.8 years (median: 3.0 years). Solid tumors predominated (81%), led by neuroblastoma (23.6%), renal tumors (17.2%), and retinoblastoma (10.7%). Five-year net survival was 69%. Multivariate Cox regression identified four independent prognostic factors: leukemia (HR=3.33, 95% CI: 2.07–5.35, p<0.001), metastatic disease (HR=2.65, 95% CI: 1.92–3.66, p<0.001), relapse (HR=2.74, 95% CI: 1.96–3.82, p<0.001), and residence >100 km from the POU (HR=1.32, 95% CI: 0.97–1.80, p=0.018).
Conclusions: Satisfactory survival outcomes are achievable in resource-limited settings with a well-structured oncology unit. Reducing geographic barriers to care and strengthening early diagnosis remain key priorities to further improve outcomes.

Keywords:

pediatric cancer, net survival, epidemiology, prognostic factors, Tunisia, low- and middle-income countries

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