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

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.

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.

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).

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.