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

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.