Jin Kyung Suh; Eun Hye Park; Meerim Park; Jun Ah Lee; Kyu-won Jung; Hyeon Jin Park

doi:10.4143/crt.2025.722

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Original Article Trends in Incidence and Survival of Childhood and Adolescent Cancer in Korea, 2001–2020: Comparison with U.S. SEER Data: Jin Kyung Suh^1,a), Eun Hye Park^2,3, Meerim Park¹, Jun Ah Lee¹, Kyu-won Jung^2,3, Hyeon Jin Park¹; DOI: https://doi.org/10.4143/crt.2025.722
Published online: January 2, 2026

¹Center for Pediatric Cancer, National Cancer Center, Goyang, Korea

²Korea Central Cancer Registry, National Cancer Center, Goyang, Korea

³Division of Cancer Registration and Surveillance, National Cancer Center, Goyang, Korea

Correspondence: Hyeon Jin Park, Center for Pediatric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea
Tel: 82-31-920-1654 E-mail: hjpark@ncc.re.kr

Co-correspondence: Kyu Won Jung, Korea Central Cancer Registry, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Korea
Tel: 82-31-920-2015 E-mail: ara@ncc.re.kr

^a)Present address: Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea

• Received: July 10, 2025 • Accepted: December 30, 2025

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract

Purpose
Childhood cancers are rare but clinically significant. Monitoring incidence and survival trends is essential for evaluating progress in cancer control and identifying areas for improvement.
Materials and Methods
We analyzed cancer incidence and survival trends among individuals aged 0-19 years in Korea using data from the Korea Central Cancer Registry from 2001 to 2020. Cancer types were classified according to the International Classification of Childhood Cancer, third edition (ICCC-3). Age-standardized incidence rates (ASRs) and annual percent changes (APCs) were calculated. Relative survival rates (RSRs) were estimated and compared with data from the United States.
Results
A total of 34,223 cancer cases were identified during the study period. The overall ASR was 151.3 per million person-years, with a significant increasing trend (APC 1.5%). Leukemias were the most common diagnostic group (ASR 43.7), followed by central nervous system tumors and lymphomas. Between 2001-2010 and 2011-2020, the 5-year and 10-year RSRs improved from 75.2% to 84.8% and from 72.7% to 82.7%, respectively. The largest survival gains were observed in leukemia (14.9 percentage points) and neuroblastoma (13.1 percentage points). Compared to Surveillance, Epidemiology, and End Results (SEER) data, Korea showed similar overall survival trends, although differences remained by cancer type and age group.
Conclusion
The incidence of childhood and adolescent cancers in Korea has increased, while survival has significantly improved over the past two decades. These findings highlight substantial progress in pediatric cancer care, while underscoring the need for targeted efforts for specific cancer subtypes and age groups.
Key words: Childhood cancer, Incidence trend, Survival rate, SEER comparison

Introduction

Cancer is an important cause of disease-related death among children worldwide. Although relatively rare compared to adult cancers, childhood cancer—defined here as cancer occurring in individuals aged 0 to 19 years [1]—represents a substantial disease burden, with nearly 400,000 new cases diagnosed globally each year [2]. The underlying reasons for the observed increase in childhood cancer incidence remain unclear. Understanding the magnitude and temporal trends of childhood cancer is essential for both public health planning and clinical decision-making. It is also critical for setting priorities in future research.

In response to these needs, many high-income countries—including Australia, Canada, Germany, Switzerland, Taiwan, and the United States—have conducted large-scale epidemiologic studies on childhood cancer incidence and trends since the late 1990s. Most of these studies reported an increasing incidence, although trends vary depending on the time period analyzed and cancer type [3-13]. In Korea, a nationwide study was previously conducted to examine the incidence and survival of childhood cancers in individuals aged 0-14 years between 1999 and 2011, marking the first comprehensive report on childhood cancer statistics in the country [9]. The present study serves as a follow-up to that initial report. In addition to assessing temporal changes in incidence and survival among Korean children and adolescents aged 0-19 years, we compared these trends with those observed in the United States using data from the SEER (Surveillance, Epidemiology, and End Results) program, in order to contextualize Korea’s progress within a global framework.

To assess interval changes and recent improvements, we analyzed trends in cancer incidence and survival among children and adolescents aged 0-19 years in Korea from 2001 to 2020. We also compared these findings with data from the U.S. SEER program to place Korea’s progress in an international context.

Materials and Methods

Data on childhood and adolescent cancer incidence and survival in Korea were obtained from the Korea National Cancer Incidence Database of the Korea Central Cancer Registry (KCCR), a nationwide, hospital-based cancer registry. The KCCR was established by the Ministry of Health and Welfare in 1980 and collects cancer cases from over 180 hospitals across the country. Since 1999, the KCCR has operated as a population-based registry covering the entire Korean population [14]. Cancer cases were coded by primary site and morphology using the International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) [15]. The registry includes data on age, sex, date of first diagnosis, primary tumor site, morphology, method of diagnosis, and stage at diagnosis. Only cases confirmed by physicians were registered, regardless of whether histologic confirmation was available.

To include adolescents—representing the transitional stage between childhood and adulthood—the study population was defined as individuals aged 0 to 19 years. Cancer diagnoses were categorized into 12 main groups and 47 subgroups according to the International Classification of Childhood Cancer, third edition (ICCC-3) [1], which is derived from the International Classification of Diseases for Oncology, third edition (ICD-O-3).

Incidence rates were calculated for individuals aged 0-19 years who were diagnosed between January 2001 and December 2020. For survival analysis, vital status was followed through December 31, 2021. Age-specific incidence rates and age-standardized incidence rates (ASRs) were calculated by sex and age group at diagnosis and expressed per million population [16]. ASRs were standardized using Segi’s world standard population as the reference. For comparison with SEER data, ASRs were recalculated using the U.S. standard population. Temporal trends in annual ASRs were assessed using annual percent change (APC), estimated by the formula 100×(e^β–1), where β is the slope derived from a linear regression of the log-transformed ASRs for the period 2001-2020 [17]. The male-to-female (M/F) ratio was calculated as the ratio of ASR in males to that in females. Comparisons of ASRs between sexes were conducted using the direct standardization method [18].

Temporal trends in childhood and adolescent cancer incidence were analyzed using Joinpoint regression. The maximum number of joinpoints was determined automatically by the software based on the number of data points in the study period (2001-2020), allowing up to four joinpoints. Model selection was performed using the Monte Carlo permutation test implemented in the Joinpoint program, which compares models with differing numbers of joinpoints to identify the most parsimonious model. Statistical significance was assessed using a two-sided permutation test with an overall significance level of 0.05. APCs and corresponding 95% confidence intervals were estimated for each identified segment, and average annual percentage changes (AAPCs) were calculated for the entire study period where appropriate.

The 5-year relative survival rates (RSRs) were analyzed by diagnostic group and time period (2001-2010 and 2011-2020) to evaluate temporal changes in survival. RSRs were calculated as the ratio of observed survival to expected survival in the general population, with expected survival derived from the standard life table published by Statistics Korea (http://kosis.kr) [19,20]. A complete approach was used to estimate RSRs, allowing for inclusion of early survival experience in more recent cohorts. This method enables more current and accurate estimates of long-term survival [21].

In addition, APCs and AAPCs in 5-year RSRs were calculated. The AAPC, a summary measure over a fixed interval, was computed as a weighted average of APCs, with weights proportional to the length of each interval [22]. All incidence and survival analyses were performed using SAS ver. 9.4 (SAS Institute Inc.), and trend analyses were conducted using Joinpoint ver. 4.9.1.0 (National Cancer Institute).

Results

1. Incidence

Between 2001 and 2020, a total of 34,223 cancer cases were newly diagnosed among children and adolescents aged 0-19 years in Korea. Of these, 2,594 cases (7.6%) were diagnosed before 1 year of age, 6,828 (20.0%) at 1-4 years, 5,504 (16.1%) at 5-9 years, 7,431 (21.7%) at 10-14 years, and 11,866 (34.7%) at 15-19 years. The distribution of cases by age group and sex, as well as ASRs and M/F ratios by diagnostic group, are presented in Table 1.

During the study period, the overall ASR for all cancers was 151.3 per million person-years, with ASRs of 155.9 and 146.4 per million in males and females, respectively. No significant overall difference was observed by sex (M/F ratio, 1.1; p > 0.05). However, significantly higher incidence rates were observed in males for certain diagnostic groups, including Burkitt lymphoma (M/F ratio, 5.6; p < 0.05), nasopharyngeal carcinoma (2.9; p < 0.05), and intracranial and intraspinal germ cell tumors (2.7; p < 0.05). In contrast, thyroid carcinoma showed significantly higher incidence in females (M/F ratio, 0.2; p < 0.05).

The highest crude incidence rate was observed among infants < 1 year of age (304.5 per million), followed by adolescents aged 15-19 years (183.0), children aged 1-4 years (175.5), 10-14 years (123.6), and 5-9 years (100.0). The high rate in infants was largely attributable to the elevated incidence of leukemias, myeloproliferative and myelodysplastic diseases (68.7 per million), neuroblastoma and other peripheral nervous cell tumors (60.7), and germ cell tumors (32.3).

Leukemias, myeloproliferative diseases, and myelodysplastic diseases (ICCC group 1) were the most common cancer group, accounting for 28% of all cases, followed by other malignant epithelial neoplasms and melanomas (group 11, 14%), lymphomas and reticuloendothelial neoplasms (group 2, 13%), central nervous system (CNS) and miscellaneous intracranial/intraspinal neoplasms (group 3, 11%), and germ cell and gonadal neoplasms (group 10, 9%). Malignant bone tumors (group 8) and soft tissue and other extraosseous sarcomas (group 9) each accounted for 6%, suggesting that together they represent the fourth most common cancer category (Fig. 1A).

Cancer distribution varied by age group. Among children aged 0-14 years, leukemias, lymphomas, CNS tumors, and germ cell tumors accounted for 33%, 13%, 13%, and 8% of all cases, respectively. In contrast, among adolescents aged 15-19 years, carcinomas were the most common (30%), followed by leukemias (20%), malignant bone and soft tissue tumors (14%), and lymphomas (13%) (Fig. 1B).

Fig. 2 shows the temporal trends in cancer incidence by diagnostic group from 2001 to 2020. Overall, the incidence of all cancers increased significantly with an APC of 1.5% per year (1.3% in males and 1.9% in females; p < 0.05). Most diagnostic groups showed increasing trends, except for ‘other and unspecified malignant neoplasms’ (group 12, APC –5.2%), renal tumors (group 6, –0.6%), malignant bone tumors (group 8, –0.5%), hepatic tumors (group 7, –0.3%), and CNS tumors (group 3, –0.2%). Significant increases in APC were observed in group 11 (other malignant epithelial neoplasms and melanomas, 5.3%), group 2 (lymphomas and reticuloendothelial neoplasms, 3.6%), group 4 (neuroblastoma and other peripheral nervous cell tumors, 1.7%), group 9 (soft tissue and other extraosseous sarcomas, 1.5%), and group 10 (germ cell and gonadal neoplasms, 1.4%). Incidence trends by sex were generally consistent, except for retinoblastoma (group 5, APC –0.3% in males vs. 0.9% in females) and hepatic tumors (group 7, APC –0.7% in males vs. 0.5% in females).

2. Survival

The survival analysis included 32,441 children and adolescents diagnosed with cancer between 2001 and 2020. As shown in Fig. 3, the 5-year RSR improved from 75.2% in 2001-2010 to 84.8% in 2011-2020, and the 10-year RSR increased from 72.7% to 82.7%, indicating absolute improvements of 9.6 and 10.0 percentage points, respectively.

Among the 12 diagnostic groups, the most substantial gains in 10-year RSR were observed in leukemias, hepatic tumors, neuroblastoma, and malignant bone tumors (Fig. 3). For example, the 10-year RSR for leukemia increased from 66.2% to 81.3%, and for neuroblastoma from 66.6% to 79.3%.

Several cancer groups, including lymphomas, retinoblastomas, renal tumors, germ cell tumors, and malignant epithelial neoplasms, consistently demonstrated high survival rates (exceeding 80% or 90%) across both time periods. In contrast, CNS tumors and soft tissue sarcomas showed limited improvement in survival.

3. Comparison of cancer incidences and survival outcomes with SEER data

To compare cancer incidence between Korea and the United States, ASRs were recalculated using the U.S. standard population rather than the world standard. Between 2014 and 2018, the ASR among individuals aged 0-19 years was higher in the United States (196.2 per million) than in Korea (164.1 per million).

Leukemias, lymphomas, carcinomas, and CNS tumors were the most prevalent cancer types in both registries. However, the incidence of CNS tumors in SEER was approximately three times higher than in KCCR (ASR 54.8 vs. 16.4). Notably, even when restricted to the same diagnostic period (2014-2018), the incidence of CNS tumors remained substantially higher in SEER than in KCCR, likely reflecting registry-specific differences in tumor classification and inclusion criteria: SEER includes both malignant and non-malignant CNS tumors, whereas KCCR includes only malignant cases.

Lymphoma incidence was also higher in SEER (ASR 32.5) compared to KCCR (24.6), which may be partly attributable to the substantially higher incidence of Hodgkin lymphoma in SEER (12.7 vs. 2.7).

Despite these differences in specific cancer types, the overall distribution of cancers by age group was similar across both registries. Among children aged 0-14 years, the most common cancers were leukemias, lymphomas, CNS tumors, and neuroblastomas. (Table 2).

Table 3 presents the 5-year RSRs by diagnostic group in both the KCCR and SEER registries. Overall survival outcomes in Korea showed substantial improvement and were comparable to those in the United States, with a 5-year RSR of 84.8% in KCCR and 85.1% in SEER for all cancers combined.

Despite the overall similarity, survival outcomes differed by cancer type. In both registries, 5-year RSRs for malignant bone tumors, soft tissue sarcomas, hepatic tumors, and CNS tumors remained below 80%, whereas survival exceeded 90% for lymphomas, retinoblastoma, renal tumors, germ cell tumors, and carcinomas.

Notably, some cancer types demonstrated higher 5-year RSRs in KCCR than in SEER. These included acute myeloid leukemia (71.0% vs. 67.7%), osteosarcoma (77.2% vs. 68.1%), and Ewing sarcoma (75.0% vs. 70.3%).

Discussion

This study provides the most comprehensive and up-to-date analysis of childhood and adolescent cancer epidemiology in Korea, based on nationwide population-level data from the KCCR. As an extension of a previous study covering children aged 0-14 years between 1999 and 2011, our analysis included adolescents up to age 19 and updated the time frame to 2020. The results revealed a continued increase in cancer incidence and significant improvements in survival outcomes.

While the earlier study reported an ASR of 134.9 per million and an APC of 2.4%, the current study showed a higher ASR of 151.3 per million but a slightly reduced APC of 1.5% during 2001-2020 [9]. This deceleration may reflect a stabilization in incidence, particularly among cancers more common in younger children. Notably, cancers such as leukemia and neuroblastoma, which predominate in early childhood, showed less increase over time.

The inclusion of adolescents highlighted a shift in cancer type distribution. While leukemia remained the most common cancer in children aged 0-14 years, adolescents showed a higher proportion of carcinomas, particularly thyroid carcinomas. The crude incidence rate of thyroid carcinoma increased dramatically with age, from 0.2 per million in children aged 1-4 years to 39.7 per million in those aged 15-19 years. This trend is consistent with prior Korean studies in adolescents and young adults, reflecting both biological and diagnostic factors [23,24]. The sharp increase in thyroid carcinoma among adolescents likely reflects, at least in part, intensified diagnostic screening and overdiagnosis, as previously reported in Korean population-based studies. This suggests that temporal increases in incidence may not solely indicate a true increase in disease burden.

When incidence was compared using the same diagnostic period (2014-2018), the overall ASR remained lower in Korea (164.1 per million) than in the United States (196.2 per million), but age-specific and diagnostic group distributions were largely similar. However, incidence rates for CNS tumors and lymphomas were notably higher in SEER. For CNS tumors, this likely reflects differences in tumor classification and inclusion criteria, as SEER includes both malignant and non-malignant tumors, whereas KCCR records only malignant cases. The higher lymphoma incidence in SEER may be attributed to the greater prevalence of Hodgkin and Burkitt lymphomas in the United States. Interestingly, although germ cell tumors are reported to be more prevalent in East Asian populations, the ASR in Korea was similar to that in SEER.

Survival outcomes showed marked improvement across the study period. The 5- and 10-year RSRs rose from 75.2% and 72.7% in 2001-2010 to 84.8% and 82.7% in 2011-2020. These gains were particularly notable in acute myeloid leukemia, myelodysplastic and myeloproliferative disorders, neuroblastoma, and Ewing sarcoma. Some cancer types—such as lymphomas, germ cell tumors, renal tumors, and carcinomas—achieved consistently favorable outcomes exceeding 90%. When compared to SEER data, survival outcomes in Korea were generally comparable or superior for several major cancer types.

However, limited improvement was observed in CNS tumors and soft tissue sarcomas, with 10-year survival rates remaining at 56.7% and 69.7%, respectively. These findings underscore the need for enhanced therapeutic approaches and research into high-risk cancers with poor prognoses. Additionally, the growing number of long-term survivors calls for systematic healthcare strategies that address late effects, quality of life, and survivorship care.

There are some limitations of this study. Stage and risk-group information was not collected in a standardized manner across all pediatric cancer types in the KCCR, which precluded stratified survival analyses. Therefore, observed improvements in survival should be interpreted with caution, as they may partly reflect changes in stage distribution or diagnostic practices over time rather than treatment effects alone.

Although calendar periods were aligned for incidence comparisons with SEER, survival comparisons were based on longer aggregated periods to ensure sufficient statistical power, which may limit direct comparability for survival outcomes. Moreover, differences in tumor classification and inclusion criteria between registries—particularly the inclusion of non-malignant CNS tumors in SEER but not in the KCCR—limit the direct comparability of incidence estimates.

This study is the first to provide representative cancer statistics on trends in incidence and survival for the full pediatric and adolescent population in Korea. The findings can inform national cancer control policy, clinical guidelines, and future research priorities. In particular, identifying modifiable risk factors and understanding treatment response variability may contribute to more effective and personalized care for pediatric and adolescent cancer patients and survivors.

NOTES

Author Contributions

Conceived and designed the analysis: Jung KW, Suh JK, Park M, Lee JA, Park HJ.

Collected the data: Jung KW, Park EH.

Contributed data or analysis tools: Jung KW, Park EH, Park HJ.

Performed the analysis: Park EH.

Wrote the paper: Jung KW, Suh JK, Park M, Lee JA, Park HJ.

Conflicts of Interest

Conflict of interest relevant to this article was not reported.

Funding

This work was supported by the National Cancer Center research grant (No. 2510681 & 24H1061).

Fig. 1.

Cancer incidence by diagnostic groups in children and adolescents (0-19 years of age) in Korea, 2001-2020. (A) Cancer incidence by diagnostic group for all age groups. (B) Cancer incidence by diagnostic group according to the age group. CNS, central nervous system.

Fig. 2.

Annual percentage change (APC) of cancer incidence by diagnostic groups of children and adolescents in Korea, 2001-2020. 1, leukaemias, myeloproliferative diseases, and myelodysplastic diseases; 2, lymphomas and reticuloendothelial neoplasms; 3, CNS and miscellaneous intracranial and intraspinal neoplasms; 4, neuroblastoma and other peripheral nervous cell tumors; 5, retinoblastoma; 6, renal tumors; 7, hepatic tumors; 8, malignant bone tumors; 9, soft tissue and other extraosseous sarcomas; 10, germ cell tumors, trophoblastic tumors, and neoplasms of gonads; 11, other malignant epithelial neoplasms and malignant melanomas; 12, other and unspecified malignant neoplasms. CNS, central nervous system.

Fig. 3.

Trends in relative survival rate (RSR) of childhood cancer in Korea according to the time period, 2001-2010 versus 2011-2020.

Table 1.

Number of cases, crude incidence rates, and ASR per million of childhood cancers in Korea for the period 2001-2020

Diagnostic group (ICCC-3)	Age group													ASR by sex		M/F ratio^a) (95% CI)
	0 yr		1-4 yr		5-9 yr		10-14 yr		15-19 yr		0-19 yr			ASR by sex
	Cases	CR	Cases	CR	Cases	CR	Cases	CR	Cases	CR	Cases	CR	ASR	Male	Female
All cancers	2,594	304.5	6,828	175.5	5,504	100	7,431	123.6	11,866	183.0	34,223	150.5	151.3	155.9	146.4	1.1 (1.0-1.1)
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	585	68.7	2,647	68.0	2,081	37.8	2,079	34.6	2,304	35.5	9,696	42.6	43.7	48.9	38.1	1.3 (1.2-1.4)
Lymphoid leukaemias	199	23.4	1,839	47.3	1,309	23.8	1,066	17.7	791	12.2	5,204	22.9	23.8	26.7	20.7	1.3 (1.2-1.4)
Acute myeloid leukaemias	149	17.5	423	10.9	440	8.0	625	10.4	768	11.8	2,405	10.6	10.6	11.3	9.8	1.2 (1.0-1.3)
Chronic myeloproliferative diseases	70	8.2	51	1.3	91	1.7	151	2.5	455	7.0	818	3.6	3.5	4.5	2.3	1.9 (1.6-2.4)
Myelodysplastic syndrome and other myeloproliferative diseases	90	10.6	125	3.2	101	1.8	101	1.7	166	2.6	583	2.6	2.7	3.1	2.2	1.4 (1.1-1.8)
Unspecified and other specified leukaemias	77	9.0	209	5.4	140	2.5	136	2.3	124	1.9	686	3.0	3.2	3.3	3.0	1.1 (0.9-1.4)
Lymphomas and reticuloendothelial neoplasms	184	21.6	714	18.4	875	15.9	1,170	19.5	1,576	24.3	4,519	19.9	19.7	24.8	14.0	1.8 (1.6-1.9)
Hodgkin lymphomas	0	0	12	0.3	43	0.8	161	2.7	392	6.0	608	2.7	2.5	3.0	1.9	1.6 (1.2-2.0)
Non-Hodgkin lymphomas (except Burkitt lymphoma)	23	2.7	169	4.3	371	6.7	584	9.7	922	14.2	2,069	9.1	8.7	10.8	6.5	1.7 (1.5-1.9)
Burkitt lymphoma	1	0.1	119	3.1	170	3.1	150	2.5	76	1.2	516	2.3	2.3	3.8	0.7	5.6 (4.1-7.6)
Miscellaneous lymphoreticular neoplasms	152	17.8	382	9.8	254	4.6	226	3.8	116	1.8	1,130	5.0	5.3	6.2	4.4	1.4 (1.2-1.7)
Unspecified lymphomas	8	0.9	32	0.8	37	0.7	49	0.8	70	1.1	196	0.9	0.9	1.1	0.6	1.8 (1.2-2.7)
CNS and miscellaneous intracranial and intraspinal neoplasms	233	27.3	795	20.4	1,013	18.4	869	14.5	851	13.1	3,761	16.5	16.9	18.1	15.6	1.2 (1.1-1.3)
Ependymomas and choroid plexus tumor	29	3.4	154	4.0	82	1.5	56	0.9	78	1.2	399	1.8	1.8	2.0	1.7	1.1 (0.9-1.5)
Astrocytomas	40	4.7	116	3.0	204	3.7	247	4.1	286	4.4	893	3.9	3.9	4.0	3.7	1.1 (0.9-1.3)
Intracranial and intraspinal embryonal tumors	95	11.1	327	8.4	366	6.6	248	4.1	148	2.3	1,184	5.2	5.5	6.0	4.8	1.2 (1.1-1.5)
Other gliomas	19	2.2	100	2.6	221	4.0	170	2.8	166	2.6	676	3.0	3.0	2.9	3.0	1.0 (0.8-1.2)
Other specified intracranial and intraspinal neoplasms	6	0.7	20	0.5	16	0.3	21	0.3	22	0.3	85	0.4	0.4	0.4	0.3	1.4 (0.8-2.5)
Unspecified intracranial and intraspinal neoplasms	44	5.2	78	2.0	124	2.3	127	2.1	151	2.3	524	2.3	2.3	2.7	1.9	1.4 (1.1-1.8)
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	517	60.7	853	21.9	178	3.2	58	1.0	55	0.8	1,661	7.3	8.4	8.8	8.1	1.1 (1.0-1.2)
Neuroblastoma and ganglioneuroblastoma	516	60.6	850	21.9	170	3.1	46	0.8	24	0.4	1,606	7.1	8.2	8.5	7.9	1.1 (0.9-1.2)
Other peripheral nervous cell tumors	1	0.1	3	0.1	8	0.1	12	0.2	31	0.5	55	0.2	0.2	0.3	0.2	1.5 (0.7-3.2)
Retinoblastoma	223	26.2	358	9.2	22	0.4	0		1	0	604	2.7	3.1	3.2	3.1	1.0 (0.8-1.3)
Renal tumors	158	18.5	382	9.8	107	1.9	44	0.7	81	1.2	772	3.4	3.8	3.8	3.7	1.0 (0.8-1.2)
Nephroblastoma and other nonepithelial renal tumors	149	17.5	364	9.4	91	1.7	20	0.3	7	0.1	631	2.8	3.2	3.2	3.2	1.0 (0.8-1.2)
Renal carcinomas	1	0.1	11	0.3	14	0.3	23	0.4	67	1.0	116	0.5	0.5	0.5	0.5	1.0 (0.6-1.6)
Unspecified malignant renal tumors	8	0.9	7	0.2	2	0	1	0	7	0.1	25	0.1	0.1	0.2	0.1	2.2 (0.7-6.6)
Hepatic tumors	147	17.3	186	4.8	54	1.0	48	0.8	101	1.6	536	2.4	2.6	2.9	2.3	1.3 (1.0-1.6)
Hepatoblastoma	135	15.8	162	4.2	36	0.7	15	0.2	8	0.1	356	1.6	1.8	2.0	1.6	1.3 (1.0-1.7)
Hepatic carcinomas	6	0.7	11	0.3	15	0.3	32	0.5	92	1.4	156	0.7	0.6	0.8	0.5	1.5 (0.9-2.4)
Unspecified malignant hepatic tumors	6	0.7	13	0.3	3	0.1	1	0	1	0	24	0.1	0.1	0.1	0.1	0.8 (0.3-2.3)
Malignant bone tumors	16	1.9	91	2.3	319	5.8	833	13.9	866	13.4	2,125	9.3	8.9	10.0	7.6	1.3 (1.2-1.5)
Osteosarcomas	0	0	22	0.6	193	3.5	618	10.3	574	8.9	1,407	6.2	5.8	6.5	5.1	1.3 (1.1-1.5)
Chondrosarcomas	0	0	0	0	3	0.1	41	0.7	84	1.3	128	0.6	0.5	0.6	0.4	1.7 (1.0-2.9)
Ewing tumor and related sarcoma of bone	11	1.3	38	1.0	74	1.3	106	1.8	115	1.8	344	1.5	1.5	1.7	1.2	1.4 (1.0-1.9)
Other specified malignant bone tumors	1	0.1	6	0.2	20	0.4	25	0.4	49	0.8	101	0.4	0.4	0.4	0.4	1.0 (0.6-1.8)
Unspecified malignant bone tumors	4	0.5	25	0.6	29	0.5	43	0.7	44	0.7	145	0.6	0.6	0.8	0.5	1.6 (1.0-2.6)
Soft tissue and other extraosseous sarcomas	145	17.0	333	8.6	279	5.1	514	8.5	799	12.3	2,070	9.1	9.0	9.6	8.4	1.1 (1.0-1.3)
Rhabdomyosarcomas	57	6.7	207	5.3	142	2.6	134	2.2	182	2.8	722	3.2	3.3	3.5	3.0	1.2 (1.0-1.5)
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	36	4.2	20	0.5	20	0.4	59	1.0	108	1.7	243	1.1	1.1	1.2	1.0	1.2 (0.8-1.7)
Kaposi sarcoma	0	0	0	0	0	0	0	0	2	0	2	0	0	0	0	0.9 (0.0-60.1)
Other specified soft tissue sarcomas	39	4.6	80	2.1	92	1.7	264	4.4	428	6.6	903	4.0	3.8	4.1	3.6	1.1 (0.9-1.4)
Unspecified soft tissue sarcomas	13	1.5	26	0.7	25	0.5	57	0.9	79	1.2	200	0.9	0.9	0.9	0.9	1.0 (0.7-1.5)
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	275	32.3	278	7.1	338	6.1	848	14.1	1,429	22.0	3,168	13.9	13.6	12.3	15.1	0.8 (0.7-0.9)
Intracranial and intraspinal germ cell tumors	25	2.9	23	0.6	176	3.2	438	7.3	411	6.3	1,073	4.7	4.5	6.5	2.4	2.7 (2.3-3.3)
Malignant extracranial and extragonadal germ cell tumors	171	20.1	74	1.9	14	0.3	36	0.6	152	2.3	447	2.0	2.1	2.1	2.2	1.0 (0.7-1.2)
Malignant gonadal germ cell tumors	75	8.8	174	4.5	141	2.6	325	5.4	622	9.6	1,337	5.9	5.7	3.6	8.0	0.5 (0.4-0.5)
Gonadal carcinomas	0	0	2	0.1	1	0	30	0.5	200	3.1	233	1.0	0.9	0	1.9	0.0 (0.0-0.0)
Other and unspecified malignant gonadal tumors	4	0.5	5	0.1	6	0.1	19	0.3	44	0.7	78	0.3	0.3	0.1	0.5	0.2 (0.1-0.5)
Other malignant epithelial neoplasms and malignant melanomas	13	1.5	47	1.2	189	3.4	873	14.5	3,587	55.3	4,709	20.7	18.8	10.6	27.8	0.4 (0.3-0.4)
Adrenocortical carcinomas	5	0.6	14	0.4	8	0.1	4	0.1	8	0.1	39	0.2	0.2	0	0.3	0.1 (0.0-0.4)
Thyroid carcinomas	0	0	6	0.2	75	1.4	480	8.0	2,571	39.7	3,132	13.8	12.4	4.6	21.0	0.2 (0.2-0.2)
Nasopharyngeal carcinomas	0	0	0	0	8	0.1	43	0.7	100	1.5	151	0.7	0.6	0.9	0.3	2.9 (1.7-4.9)
Malignant melanomas	4	0.5	14	0.4	18	0.3	25	0.4	41	0.6	102	0.4	0.4	0.4	0.5	0.9 (0.5-1.5)
Skin carcinomas	1	0.1	5	0.1	13	0.2	23	0.4	39	0.6	81	0.4	0.3	0.3	0.4	0.8 (0.4-1.5)
Other and unspecified carcinomas	3	0.4	8	0.2	67	1.2	298	5.0	828	12.8	1,204	5.3	4.8	4.4	5.4	0.8 (0.7-1.0)
Other and unspecified malignant neoplasms	93	10.9	138	3.5	39	0.7	82	1.4	185	2.9	537	2.4	2.5	2.5	2.4	1.0 (0.8-1.3)
Other specified malignant tumors	4	0.5	30	0.8	2	0	17	0.3	32	0.5	85	0.4	0.4	0.3	0.5	0.5 (0.3-1.0)
Other unspecified malignant tumors	89	10.4	108	2.8	37	0.7	65	1.1	153	2.4	452	2.0	2.1	2.2	1.9	1.2 (0.9-1.5)
Not classified by ICCC	5	0.6	6	0.2	10	0.2	13	0.2	31	0.5	65	0.3	0.3	0.3	0.3	0.8 (0.4-1.7)

ASR, age standardized incidence rate (per million); CI, confidence interval; CNS, central nervous system; CR, crude incidence rate (per million); ICCC-3, International Classification of Childhood Cancer, 3rd edition.

^a) M/F ratio=male ASR/female ASR.

Table 2.

Childhood cancer incidence according to the age group compared with SEER data, 2014-2018

Diagnostic group (ICCC-3)	Age group (ASR)
	0-14 yr		0-19 yr
	KCCR	SEER	KCCR	SEER
All cancers	149.9	177.6	164.1	196.2
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	48.5	54.7	46.3	50.2
Lymphoid leukaemias	29.0	41.9	25.2	36.2
Acute myeloid leukaemias	9.3	8.3	9.9	8.7
Chronic myeloproliferative diseases	3.2	1.7	4.8	2.6
Myelodysplastic syndrome and other myeloproliferative diseases	2.9	1.6	3.0	1.6
Unspecified and other specified leukaemias	4.0	1.1	3.4	1.1
Lymphomas and reticuloendothelial neoplasms	23.4	24.2	24.6	32.5
Hodgkin lymphomas	1.2	5.8	2.7	12.7
Non-Hodgkin lymphomas (except Burkitt lymphoma)	7.2	9.0	9.5	11.5
Burkitt lymphoma	3.3	2.6	2.8	2.6
Miscellaneous lymphoreticular neoplasms	11.3	6.5	9.2	5.3
Unspecified lymphomas	0.4	0.2	0.4	0.4
CNS and miscellaneous intracranial and intraspinal neoplasms	17.8	51.6^a)	16.4	54.8^a)
Ependymomas and choroid plexus tumor	2.2	4.6	2.0	4.3
Astrocytomas	4.1	18.4	4.3	17.2
Intracranial and intraspinal embryonal tumors	6.1	7.2	4.9	6.0
Other gliomas	4.2	6.7	3.9	6.3
Other specified intracranial and intraspinal neoplasms	0.5	12.6	0.5	19.0
Unspecified intracranial and intraspinal neoplasms	0.7	2.0	0.8	2.0
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	11.0	10.7	8.5	8.3
Neuroblastoma and ganglioneuroblastoma	10.8	10.5	8.2	8.1
Other peripheral nervous cell tumors	0.2	0.2	0.3	0.2
Retinoblastoma	4.2	4.2	3.1	3.1
Renal tumors	4.4	8.9	3.6	7.1
Nephroblastoma and other nonepithelial renal tumors	3.9	8.4	2.9	6.4
Renal carcinomas	0.4	0.5	0.6	0.7
Unspecified malignant renal tumors	0.1	-	0.2	-
Hepatic tumors	2.5	3.3	2.2	2.9
Hepatoblastoma	2.2	2.9	1.7	2.2
Hepatic carcinomas	0.2	0.4	0.4	0.7
Unspecified malignant hepatic tumors	0.1	-	0.1	-
Malignant bone tumors	7.3	8.2	8.8	9.9
Osteosarcomas	4.9	4.7	5.9	5.7
Chondrosarcomas	0.3	0.3	0.7	0.4
Ewing tumor and related sarcoma of bone	1.1	2.8	1.2	3.1
Other specified malignant bone tumors	0.2	0.4	0.3	0.5
Unspecified malignant bone tumors	0.7	-	0.6	0.2
Soft tissue and other extraosseous sarcomas	8.8	11.0	9.9	12.6
Rhabdomyosarcomas	3.4	4.9	3.3	4.5
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	1.0	1.0	1.1	1.3
Kaposi sarcoma	-	-	0	-
Other specified soft tissue sarcomas	3.5	3.7	4.5	5.2
Unspecified soft tissue sarcomas	0.9	1.3	1.0	1.6
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	11.3	6.1	14.2	11.8
Intracranial and intraspinal germ cell tumors	3.9	1.6	4.7	1.9
Malignant extracranial and extragonadal germ cell tumors	2.7	1.5	2.8	1.4
Malignant gonadal germ cell tumors	4.2	2.8	5.5	7.6
Gonadal carcinomas	0.2	-	0.8	0.5
Other and unspecified malignant gonadal tumors	0.2	-	0.4	0.3
Other malignant epithelial neoplasms and malignant melanomas	8.5	10.8	23.9	25.3
Adrenocortical carcinomas	0.2	0.2	0.2	0.2
Thyroid carcinomas	4.3	4.2	15.9	12.0
Nasopharyngeal carcinomas	0.3	0.2	0.7	0.4
Malignant melanomas	0.3	2.0	0.4	3.7
Skin carcinomas	0.3	-	0.4	0.2
Other and unspecified carcinomas	3.0	4.1	6.3	8.7
Other and unspecified malignant neoplasms	1.7	0.8	1.9	0.8
Other specified malignant tumors	0.3	0.6	0.4	0.6
Other unspecified malignant tumors	1.4	0.2	1.5	0.2
Not classified by ICCC	0.6	-	0.6	-

ASR, age standardized incidence rate; CNS, central nervous system; ICCC-3, International Classification of Childhood Cancer, 3rd edition; KCCR, Korea Central Cancer Registry; SEER, Surveillance, Epidemiology, and End Results.

^a) Higher incidence of CNS tumors in SEER than in KCCR reflects registry-specific differences in tumor classification and inclusion criteria: SEER includes both malignant and nonmalignant CNS tumors, whereas KCCR includes only malignant cases.

Table 3.

Childhood cancer 5-year relative survival rates compared to SEER data

Diagnostic group (ICCC-3)	KCCR (%) (2011-2020)	SEER (%) (2011-2017)
All cancers	84.8	85.1
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	83.2	85.1
Lymphoid leukaemias	85.8	89.4
Acute myeloid leukaemias	71.0	67.7
Chronic myeloproliferative diseases	95.0	-^a)
Myelodysplastic syndrome and other myeloproliferative diseases	82.2	-
Unspecified and other specified leukaemias	85.2	-
Lymphomas and reticuloendothelial neoplasms	91.3	94.3
Hodgkin lymphomas	95.2	97.8
Non-Hodgkin lymphomas (except Burkitt lymphoma)	85.0	89.9^b)
Burkitt lymphoma	89.0	-
Miscellaneous lymphoreticular neoplasms	98.3	-
Unspecified lymphomas	87.8	-
CNS and miscellaneous intracranial and intraspinal neoplasms	61.2	74.2^c)
Ependymomas and choroid plexus tumor	76.6	82.9
Astrocytomas	57.2	80.3
Intracranial and intraspinal embryonal tumors	61.4	67.5
Other gliomas	50.9	61.0
Other specified intracranial and intraspinal neoplasms	76.8	-
Unspecified intracranial and intraspinal neoplasms	79.8	-
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	83.9	81.7
Neuroblastoma and ganglioneuroblastoma	83.5	81.6
Other peripheral nervous cell tumors	92.0	-
Retinoblastoma	96.0	95.9
Renal tumors	91.5	91.4
Nephroblastoma and other nonepithelial renal tumors	92.9	93.2
Renal carcinomas	83.7	-
Unspecified malignant renal tumors	100.2	-
Hepatic tumors	77.5	77.6
Hepatoblastoma	84.9	82.4
Hepatic carcinomas	49.2	-
Unspecified malignant hepatic tumors	85.9	-
Malignant bone tumors	80.0	71.1
Osteosarcomas	77.2	68.1
Chondrosarcomas	95.6	-
Ewing tumor and related sarcoma of bone	75.0	70.3
Other specified malignant bone tumors	94.3	-
Unspecified malignant bone tumors	90.1	-
Soft tissue and other extraosseous sarcomas	74.0	73.7
Rhabdomyosarcomas	65.8	66.0
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	72.4	-
Kaposi sarcoma	100.1	-
Other specified soft tissue sarcomas	79.9	-
Unspecified soft tissue sarcomas	72.8	-
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	92.0	92.0
Intracranial and intraspinal germ cell tumors	89.8	89.4
Malignant extracranial and extragonadal germ cell tumors	85.6	-
Malignant gonadal germ cell tumors	98.1	96.0
Gonadal carcinomas	78.9	-
Other and unspecified malignant gonadal tumors	91.2	-
Other malignant epithelial neoplasms and malignant melanomas	95.5	94.4
Adrenocortical carcinomas	67.6	-
Thyroid carcinomas	99.9	99.8
Nasopharyngeal carcinomas	85.8	-
Malignant melanomas	80.8	94.9
Skin carcinomas	93.9	-
Other and unspecified carcinomas	85.4	-
Other and unspecified malignant neoplasms	83.2	-
Other specified malignant tumors	86.5	-
Other unspecified malignant tumors	81.9	-
Not classified by ICCC	79.5	-

CNS, central nervous system; ICCC-3, International Classification of Childhood Cancer, 3rd edition; KCCR, Korea Central Cancer Registry; SEER, Surveillance, Epidemiology, and End Results.

^a) No SEER value is presented for these subgroups, as the corresponding survival data were not reported in the original U.S. publication,

^b) The SEER 5-year survival rate for “Non-Hodgkin lymphomas (except Burkitt lymphoma)”, “Burkitt lymphoma”, and “Unspecified lymphomas” was combined and reported as a single value (89.9%),

^c) Higher incidence of CNS tumors in SEER than in KCCR reflects registry-specific differences in tumor classification and inclusion criteria: SEER includes both malignant and non-malignant CNS tumors, whereas KCCR includes only malignant cases.

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Trends in Incidence and Survival of Childhood and Adolescent Cancer in Korea, 2001–2020: Comparison with U.S. SEER Data

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Abstract
Introduction
Materials and Methods
Results
Discussion
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REFERENCES

Trends in Incidence and Survival of Childhood and Adolescent Cancer in Korea, 2001–2020: Comparison with U.S. SEER Data

Fig. 1. Cancer incidence by diagnostic groups in children and adolescents (0-19 years of age) in Korea, 2001-2020. (A) Cancer incidence by diagnostic group for all age groups. (B) Cancer incidence by diagnostic group according to the age group. CNS, central nervous system.

Fig. 2. Annual percentage change (APC) of cancer incidence by diagnostic groups of children and adolescents in Korea, 2001-2020. 1, leukaemias, myeloproliferative diseases, and myelodysplastic diseases; 2, lymphomas and reticuloendothelial neoplasms; 3, CNS and miscellaneous intracranial and intraspinal neoplasms; 4, neuroblastoma and other peripheral nervous cell tumors; 5, retinoblastoma; 6, renal tumors; 7, hepatic tumors; 8, malignant bone tumors; 9, soft tissue and other extraosseous sarcomas; 10, germ cell tumors, trophoblastic tumors, and neoplasms of gonads; 11, other malignant epithelial neoplasms and malignant melanomas; 12, other and unspecified malignant neoplasms. CNS, central nervous system.

Fig. 3. Trends in relative survival rate (RSR) of childhood cancer in Korea according to the time period, 2001-2010 versus 2011-2020.

Fig. 1.

Fig. 2.

Fig. 3.

Trends in Incidence and Survival of Childhood and Adolescent Cancer in Korea, 2001–2020: Comparison with U.S. SEER Data

Diagnostic group (ICCC-3)	Age group													ASR by sex		M/F ratio^a) (95% CI)
	0 yr		1-4 yr		5-9 yr		10-14 yr		15-19 yr		0-19 yr			ASR by sex
	Cases	CR	Cases	CR	Cases	CR	Cases	CR	Cases	CR	Cases	CR	ASR	Male	Female
All cancers	2,594	304.5	6,828	175.5	5,504	100	7,431	123.6	11,866	183.0	34,223	150.5	151.3	155.9	146.4	1.1 (1.0-1.1)
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	585	68.7	2,647	68.0	2,081	37.8	2,079	34.6	2,304	35.5	9,696	42.6	43.7	48.9	38.1	1.3 (1.2-1.4)
Lymphoid leukaemias	199	23.4	1,839	47.3	1,309	23.8	1,066	17.7	791	12.2	5,204	22.9	23.8	26.7	20.7	1.3 (1.2-1.4)
Acute myeloid leukaemias	149	17.5	423	10.9	440	8.0	625	10.4	768	11.8	2,405	10.6	10.6	11.3	9.8	1.2 (1.0-1.3)
Chronic myeloproliferative diseases	70	8.2	51	1.3	91	1.7	151	2.5	455	7.0	818	3.6	3.5	4.5	2.3	1.9 (1.6-2.4)
Myelodysplastic syndrome and other myeloproliferative diseases	90	10.6	125	3.2	101	1.8	101	1.7	166	2.6	583	2.6	2.7	3.1	2.2	1.4 (1.1-1.8)
Unspecified and other specified leukaemias	77	9.0	209	5.4	140	2.5	136	2.3	124	1.9	686	3.0	3.2	3.3	3.0	1.1 (0.9-1.4)
Lymphomas and reticuloendothelial neoplasms	184	21.6	714	18.4	875	15.9	1,170	19.5	1,576	24.3	4,519	19.9	19.7	24.8	14.0	1.8 (1.6-1.9)
Hodgkin lymphomas	0	0	12	0.3	43	0.8	161	2.7	392	6.0	608	2.7	2.5	3.0	1.9	1.6 (1.2-2.0)
Non-Hodgkin lymphomas (except Burkitt lymphoma)	23	2.7	169	4.3	371	6.7	584	9.7	922	14.2	2,069	9.1	8.7	10.8	6.5	1.7 (1.5-1.9)
Burkitt lymphoma	1	0.1	119	3.1	170	3.1	150	2.5	76	1.2	516	2.3	2.3	3.8	0.7	5.6 (4.1-7.6)
Miscellaneous lymphoreticular neoplasms	152	17.8	382	9.8	254	4.6	226	3.8	116	1.8	1,130	5.0	5.3	6.2	4.4	1.4 (1.2-1.7)
Unspecified lymphomas	8	0.9	32	0.8	37	0.7	49	0.8	70	1.1	196	0.9	0.9	1.1	0.6	1.8 (1.2-2.7)
CNS and miscellaneous intracranial and intraspinal neoplasms	233	27.3	795	20.4	1,013	18.4	869	14.5	851	13.1	3,761	16.5	16.9	18.1	15.6	1.2 (1.1-1.3)
Ependymomas and choroid plexus tumor	29	3.4	154	4.0	82	1.5	56	0.9	78	1.2	399	1.8	1.8	2.0	1.7	1.1 (0.9-1.5)
Astrocytomas	40	4.7	116	3.0	204	3.7	247	4.1	286	4.4	893	3.9	3.9	4.0	3.7	1.1 (0.9-1.3)
Intracranial and intraspinal embryonal tumors	95	11.1	327	8.4	366	6.6	248	4.1	148	2.3	1,184	5.2	5.5	6.0	4.8	1.2 (1.1-1.5)
Other gliomas	19	2.2	100	2.6	221	4.0	170	2.8	166	2.6	676	3.0	3.0	2.9	3.0	1.0 (0.8-1.2)
Other specified intracranial and intraspinal neoplasms	6	0.7	20	0.5	16	0.3	21	0.3	22	0.3	85	0.4	0.4	0.4	0.3	1.4 (0.8-2.5)
Unspecified intracranial and intraspinal neoplasms	44	5.2	78	2.0	124	2.3	127	2.1	151	2.3	524	2.3	2.3	2.7	1.9	1.4 (1.1-1.8)
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	517	60.7	853	21.9	178	3.2	58	1.0	55	0.8	1,661	7.3	8.4	8.8	8.1	1.1 (1.0-1.2)
Neuroblastoma and ganglioneuroblastoma	516	60.6	850	21.9	170	3.1	46	0.8	24	0.4	1,606	7.1	8.2	8.5	7.9	1.1 (0.9-1.2)
Other peripheral nervous cell tumors	1	0.1	3	0.1	8	0.1	12	0.2	31	0.5	55	0.2	0.2	0.3	0.2	1.5 (0.7-3.2)
Retinoblastoma	223	26.2	358	9.2	22	0.4	0		1	0	604	2.7	3.1	3.2	3.1	1.0 (0.8-1.3)
Renal tumors	158	18.5	382	9.8	107	1.9	44	0.7	81	1.2	772	3.4	3.8	3.8	3.7	1.0 (0.8-1.2)
Nephroblastoma and other nonepithelial renal tumors	149	17.5	364	9.4	91	1.7	20	0.3	7	0.1	631	2.8	3.2	3.2	3.2	1.0 (0.8-1.2)
Renal carcinomas	1	0.1	11	0.3	14	0.3	23	0.4	67	1.0	116	0.5	0.5	0.5	0.5	1.0 (0.6-1.6)
Unspecified malignant renal tumors	8	0.9	7	0.2	2	0	1	0	7	0.1	25	0.1	0.1	0.2	0.1	2.2 (0.7-6.6)
Hepatic tumors	147	17.3	186	4.8	54	1.0	48	0.8	101	1.6	536	2.4	2.6	2.9	2.3	1.3 (1.0-1.6)
Hepatoblastoma	135	15.8	162	4.2	36	0.7	15	0.2	8	0.1	356	1.6	1.8	2.0	1.6	1.3 (1.0-1.7)
Hepatic carcinomas	6	0.7	11	0.3	15	0.3	32	0.5	92	1.4	156	0.7	0.6	0.8	0.5	1.5 (0.9-2.4)
Unspecified malignant hepatic tumors	6	0.7	13	0.3	3	0.1	1	0	1	0	24	0.1	0.1	0.1	0.1	0.8 (0.3-2.3)
Malignant bone tumors	16	1.9	91	2.3	319	5.8	833	13.9	866	13.4	2,125	9.3	8.9	10.0	7.6	1.3 (1.2-1.5)
Osteosarcomas	0	0	22	0.6	193	3.5	618	10.3	574	8.9	1,407	6.2	5.8	6.5	5.1	1.3 (1.1-1.5)
Chondrosarcomas	0	0	0	0	3	0.1	41	0.7	84	1.3	128	0.6	0.5	0.6	0.4	1.7 (1.0-2.9)
Ewing tumor and related sarcoma of bone	11	1.3	38	1.0	74	1.3	106	1.8	115	1.8	344	1.5	1.5	1.7	1.2	1.4 (1.0-1.9)
Other specified malignant bone tumors	1	0.1	6	0.2	20	0.4	25	0.4	49	0.8	101	0.4	0.4	0.4	0.4	1.0 (0.6-1.8)
Unspecified malignant bone tumors	4	0.5	25	0.6	29	0.5	43	0.7	44	0.7	145	0.6	0.6	0.8	0.5	1.6 (1.0-2.6)
Soft tissue and other extraosseous sarcomas	145	17.0	333	8.6	279	5.1	514	8.5	799	12.3	2,070	9.1	9.0	9.6	8.4	1.1 (1.0-1.3)
Rhabdomyosarcomas	57	6.7	207	5.3	142	2.6	134	2.2	182	2.8	722	3.2	3.3	3.5	3.0	1.2 (1.0-1.5)
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	36	4.2	20	0.5	20	0.4	59	1.0	108	1.7	243	1.1	1.1	1.2	1.0	1.2 (0.8-1.7)
Kaposi sarcoma	0	0	0	0	0	0	0	0	2	0	2	0	0	0	0	0.9 (0.0-60.1)
Other specified soft tissue sarcomas	39	4.6	80	2.1	92	1.7	264	4.4	428	6.6	903	4.0	3.8	4.1	3.6	1.1 (0.9-1.4)
Unspecified soft tissue sarcomas	13	1.5	26	0.7	25	0.5	57	0.9	79	1.2	200	0.9	0.9	0.9	0.9	1.0 (0.7-1.5)
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	275	32.3	278	7.1	338	6.1	848	14.1	1,429	22.0	3,168	13.9	13.6	12.3	15.1	0.8 (0.7-0.9)
Intracranial and intraspinal germ cell tumors	25	2.9	23	0.6	176	3.2	438	7.3	411	6.3	1,073	4.7	4.5	6.5	2.4	2.7 (2.3-3.3)
Malignant extracranial and extragonadal germ cell tumors	171	20.1	74	1.9	14	0.3	36	0.6	152	2.3	447	2.0	2.1	2.1	2.2	1.0 (0.7-1.2)
Malignant gonadal germ cell tumors	75	8.8	174	4.5	141	2.6	325	5.4	622	9.6	1,337	5.9	5.7	3.6	8.0	0.5 (0.4-0.5)
Gonadal carcinomas	0	0	2	0.1	1	0	30	0.5	200	3.1	233	1.0	0.9	0	1.9	0.0 (0.0-0.0)
Other and unspecified malignant gonadal tumors	4	0.5	5	0.1	6	0.1	19	0.3	44	0.7	78	0.3	0.3	0.1	0.5	0.2 (0.1-0.5)
Other malignant epithelial neoplasms and malignant melanomas	13	1.5	47	1.2	189	3.4	873	14.5	3,587	55.3	4,709	20.7	18.8	10.6	27.8	0.4 (0.3-0.4)
Adrenocortical carcinomas	5	0.6	14	0.4	8	0.1	4	0.1	8	0.1	39	0.2	0.2	0	0.3	0.1 (0.0-0.4)
Thyroid carcinomas	0	0	6	0.2	75	1.4	480	8.0	2,571	39.7	3,132	13.8	12.4	4.6	21.0	0.2 (0.2-0.2)
Nasopharyngeal carcinomas	0	0	0	0	8	0.1	43	0.7	100	1.5	151	0.7	0.6	0.9	0.3	2.9 (1.7-4.9)
Malignant melanomas	4	0.5	14	0.4	18	0.3	25	0.4	41	0.6	102	0.4	0.4	0.4	0.5	0.9 (0.5-1.5)
Skin carcinomas	1	0.1	5	0.1	13	0.2	23	0.4	39	0.6	81	0.4	0.3	0.3	0.4	0.8 (0.4-1.5)
Other and unspecified carcinomas	3	0.4	8	0.2	67	1.2	298	5.0	828	12.8	1,204	5.3	4.8	4.4	5.4	0.8 (0.7-1.0)
Other and unspecified malignant neoplasms	93	10.9	138	3.5	39	0.7	82	1.4	185	2.9	537	2.4	2.5	2.5	2.4	1.0 (0.8-1.3)
Other specified malignant tumors	4	0.5	30	0.8	2	0	17	0.3	32	0.5	85	0.4	0.4	0.3	0.5	0.5 (0.3-1.0)
Other unspecified malignant tumors	89	10.4	108	2.8	37	0.7	65	1.1	153	2.4	452	2.0	2.1	2.2	1.9	1.2 (0.9-1.5)
Not classified by ICCC	5	0.6	6	0.2	10	0.2	13	0.2	31	0.5	65	0.3	0.3	0.3	0.3	0.8 (0.4-1.7)

Diagnostic group (ICCC-3)	Age group (ASR)
	0-14 yr		0-19 yr
	KCCR	SEER	KCCR	SEER
All cancers	149.9	177.6	164.1	196.2
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	48.5	54.7	46.3	50.2
Lymphoid leukaemias	29.0	41.9	25.2	36.2
Acute myeloid leukaemias	9.3	8.3	9.9	8.7
Chronic myeloproliferative diseases	3.2	1.7	4.8	2.6
Myelodysplastic syndrome and other myeloproliferative diseases	2.9	1.6	3.0	1.6
Unspecified and other specified leukaemias	4.0	1.1	3.4	1.1
Lymphomas and reticuloendothelial neoplasms	23.4	24.2	24.6	32.5
Hodgkin lymphomas	1.2	5.8	2.7	12.7
Non-Hodgkin lymphomas (except Burkitt lymphoma)	7.2	9.0	9.5	11.5
Burkitt lymphoma	3.3	2.6	2.8	2.6
Miscellaneous lymphoreticular neoplasms	11.3	6.5	9.2	5.3
Unspecified lymphomas	0.4	0.2	0.4	0.4
CNS and miscellaneous intracranial and intraspinal neoplasms	17.8	51.6^a)	16.4	54.8^a)
Ependymomas and choroid plexus tumor	2.2	4.6	2.0	4.3
Astrocytomas	4.1	18.4	4.3	17.2
Intracranial and intraspinal embryonal tumors	6.1	7.2	4.9	6.0
Other gliomas	4.2	6.7	3.9	6.3
Other specified intracranial and intraspinal neoplasms	0.5	12.6	0.5	19.0
Unspecified intracranial and intraspinal neoplasms	0.7	2.0	0.8	2.0
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	11.0	10.7	8.5	8.3
Neuroblastoma and ganglioneuroblastoma	10.8	10.5	8.2	8.1
Other peripheral nervous cell tumors	0.2	0.2	0.3	0.2
Retinoblastoma	4.2	4.2	3.1	3.1
Renal tumors	4.4	8.9	3.6	7.1
Nephroblastoma and other nonepithelial renal tumors	3.9	8.4	2.9	6.4
Renal carcinomas	0.4	0.5	0.6	0.7
Unspecified malignant renal tumors	0.1	-	0.2	-
Hepatic tumors	2.5	3.3	2.2	2.9
Hepatoblastoma	2.2	2.9	1.7	2.2
Hepatic carcinomas	0.2	0.4	0.4	0.7
Unspecified malignant hepatic tumors	0.1	-	0.1	-
Malignant bone tumors	7.3	8.2	8.8	9.9
Osteosarcomas	4.9	4.7	5.9	5.7
Chondrosarcomas	0.3	0.3	0.7	0.4
Ewing tumor and related sarcoma of bone	1.1	2.8	1.2	3.1
Other specified malignant bone tumors	0.2	0.4	0.3	0.5
Unspecified malignant bone tumors	0.7	-	0.6	0.2
Soft tissue and other extraosseous sarcomas	8.8	11.0	9.9	12.6
Rhabdomyosarcomas	3.4	4.9	3.3	4.5
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	1.0	1.0	1.1	1.3
Kaposi sarcoma	-	-	0	-
Other specified soft tissue sarcomas	3.5	3.7	4.5	5.2
Unspecified soft tissue sarcomas	0.9	1.3	1.0	1.6
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	11.3	6.1	14.2	11.8
Intracranial and intraspinal germ cell tumors	3.9	1.6	4.7	1.9
Malignant extracranial and extragonadal germ cell tumors	2.7	1.5	2.8	1.4
Malignant gonadal germ cell tumors	4.2	2.8	5.5	7.6
Gonadal carcinomas	0.2	-	0.8	0.5
Other and unspecified malignant gonadal tumors	0.2	-	0.4	0.3
Other malignant epithelial neoplasms and malignant melanomas	8.5	10.8	23.9	25.3
Adrenocortical carcinomas	0.2	0.2	0.2	0.2
Thyroid carcinomas	4.3	4.2	15.9	12.0
Nasopharyngeal carcinomas	0.3	0.2	0.7	0.4
Malignant melanomas	0.3	2.0	0.4	3.7
Skin carcinomas	0.3	-	0.4	0.2
Other and unspecified carcinomas	3.0	4.1	6.3	8.7
Other and unspecified malignant neoplasms	1.7	0.8	1.9	0.8
Other specified malignant tumors	0.3	0.6	0.4	0.6
Other unspecified malignant tumors	1.4	0.2	1.5	0.2
Not classified by ICCC	0.6	-	0.6	-

Diagnostic group (ICCC-3)	KCCR (%) (2011-2020)	SEER (%) (2011-2017)
All cancers	84.8	85.1
Leukaemias, myeloproliferative diseases, and myelodysplastic diseases	83.2	85.1
Lymphoid leukaemias	85.8	89.4
Acute myeloid leukaemias	71.0	67.7
Chronic myeloproliferative diseases	95.0	-^a)
Myelodysplastic syndrome and other myeloproliferative diseases	82.2	-
Unspecified and other specified leukaemias	85.2	-
Lymphomas and reticuloendothelial neoplasms	91.3	94.3
Hodgkin lymphomas	95.2	97.8
Non-Hodgkin lymphomas (except Burkitt lymphoma)	85.0	89.9^b)
Burkitt lymphoma	89.0	-
Miscellaneous lymphoreticular neoplasms	98.3	-
Unspecified lymphomas	87.8	-
CNS and miscellaneous intracranial and intraspinal neoplasms	61.2	74.2^c)
Ependymomas and choroid plexus tumor	76.6	82.9
Astrocytomas	57.2	80.3
Intracranial and intraspinal embryonal tumors	61.4	67.5
Other gliomas	50.9	61.0
Other specified intracranial and intraspinal neoplasms	76.8	-
Unspecified intracranial and intraspinal neoplasms	79.8	-
Neuroblastoma and other peripheral nervous cell tumors sympathetic nervous system tumors	83.9	81.7
Neuroblastoma and ganglioneuroblastoma	83.5	81.6
Other peripheral nervous cell tumors	92.0	-
Retinoblastoma	96.0	95.9
Renal tumors	91.5	91.4
Nephroblastoma and other nonepithelial renal tumors	92.9	93.2
Renal carcinomas	83.7	-
Unspecified malignant renal tumors	100.2	-
Hepatic tumors	77.5	77.6
Hepatoblastoma	84.9	82.4
Hepatic carcinomas	49.2	-
Unspecified malignant hepatic tumors	85.9	-
Malignant bone tumors	80.0	71.1
Osteosarcomas	77.2	68.1
Chondrosarcomas	95.6	-
Ewing tumor and related sarcoma of bone	75.0	70.3
Other specified malignant bone tumors	94.3	-
Unspecified malignant bone tumors	90.1	-
Soft tissue and other extraosseous sarcomas	74.0	73.7
Rhabdomyosarcomas	65.8	66.0
Fibrosarcomas, peripheral nerve sheath tumors, and other fibrous neoplasms	72.4	-
Kaposi sarcoma	100.1	-
Other specified soft tissue sarcomas	79.9	-
Unspecified soft tissue sarcomas	72.8	-
Germ cell tumors, trophoblastic tumors, and neoplasms of gonads	92.0	92.0
Intracranial and intraspinal germ cell tumors	89.8	89.4
Malignant extracranial and extragonadal germ cell tumors	85.6	-
Malignant gonadal germ cell tumors	98.1	96.0
Gonadal carcinomas	78.9	-
Other and unspecified malignant gonadal tumors	91.2	-
Other malignant epithelial neoplasms and malignant melanomas	95.5	94.4
Adrenocortical carcinomas	67.6	-
Thyroid carcinomas	99.9	99.8
Nasopharyngeal carcinomas	85.8	-
Malignant melanomas	80.8	94.9
Skin carcinomas	93.9	-
Other and unspecified carcinomas	85.4	-
Other and unspecified malignant neoplasms	83.2	-
Other specified malignant tumors	86.5	-
Other unspecified malignant tumors	81.9	-
Not classified by ICCC	79.5	-

Table 1. Number of cases, crude incidence rates, and ASR per million of childhood cancers in Korea for the period 2001-2020

M/F ratio=male ASR/female ASR.

Table 2. Childhood cancer incidence according to the age group compared with SEER data, 2014-2018

Higher incidence of CNS tumors in SEER than in KCCR reflects registry-specific differences in tumor classification and inclusion criteria: SEER includes both malignant and nonmalignant CNS tumors, whereas KCCR includes only malignant cases.

Table 3. Childhood cancer 5-year relative survival rates compared to SEER data

CNS, central nervous system; ICCC-3, International Classification of Childhood Cancer, 3rd edition; KCCR, Korea Central Cancer Registry; SEER, Surveillance, Epidemiology, and End Results.

No SEER value is presented for these subgroups, as the corresponding survival data were not reported in the original U.S. publication,

The SEER 5-year survival rate for “Non-Hodgkin lymphomas (except Burkitt lymphoma)”, “Burkitt lymphoma”, and “Unspecified lymphomas” was combined and reported as a single value (89.9%),

Higher incidence of CNS tumors in SEER than in KCCR reflects registry-specific differences in tumor classification and inclusion criteria: SEER includes both malignant and non-malignant CNS tumors, whereas KCCR includes only malignant cases.