《多伦多儿童癌症分期指南》是一本分期系统汇编，旨在通过癌症登记处收集具有一致性和可比性的儿童癌症诊断分期数据。本回顾性观察性队列研究使用基于人口的澳大利亚儿童癌症登记处的资料，调查了2000年至2008年和2009年至2017年被诊断的儿童癌症患者分期特定发病率和存活率的变化。每个患者的死亡信息截至2020年12月31日。使用卡方检验评估了分期发病率的变化，并使用柔性参数模型评估了各期五年内因各种死因而观察到的存活率在时间上的差异。根据《多伦多指南》，对总研究队列（n = 8292）中的96％（n = 7944）的患者进行了分期。“视网膜母细胞瘤”的阶段分布在两个诊断期间发生了变化，0期占病例的比例从26％增加到37％（p = 0.02），并且“肝母细胞瘤”的转移性疾病占病例的比例从22％增加到39％（p = 0.04）。对于阶段IV的横纹肌肉瘤，经过调整的五年死亡风险比（2009-2017与2000-2008相比）为0.38（95％CI为0.19-0.77；p = 0.01）；对于M3期的小脑母细胞瘤，HR = 0.41（95％CI为0.21-0.79；p = 0.01）；对于除MS期以外的转移性神经母细胞瘤，HR = 0.61（95％CI为0.44-0.84；p < 0.01），随时间的推移，阶段特异性的存活率有显著提高。研究结果表明，澳大利亚儿童癌症存活率的改善很可能是由于精细的治疗管理，而不是诊断时期的变化，尤其是对于转移性实体肿瘤。《多伦多指南》在国际范围内得到广泛采用，将有助于全面评估各国之间存活率的差异。

The Toronto Paediatric Cancer Stage Guidelines are a compendium of staging systems developed to facilitate collection of consistent and comparable data on stage at diagnosis for childhood cancers by cancer registries.This retrospective, observational cohort study investigated changes in stage-specific incidence and survival for children diagnosed between 2000-2008 compared to 2009-2017 using the population-based Australian Childhood Cancer Registry. Information on mortality for each patient was available to 31st December 2020. Shifts in incidence by stage were evaluated using chi-square tests, and differences in stage-specific five-year observed survival for all causes of death over time were assessed using flexible parametric models.Stage was assigned according to the Toronto Guidelines for 96% (n = 7944) of the total study cohort (n = 8292). Changes in the distribution of incidence by stage between the two diagnosis periods were observed for retinoblastoma, with stage 0 increasing from 26% to 37% of cases (p = 0.02), and hepatoblastoma, with metastatic disease increasing from 22% to 39% of cases (p = 0.04). There were large gains in stage-specific survival over time for stage IV rhabdomyosarcoma (five-year adjusted mortality hazard ratio for 2009-2017 compared to 2000-2008 of 0.38, 95% CI 0.19-0.77; p = 0.01), stage M3 for medulloblastoma (HR = 0.41, 95% CI 0.21-0.79; p = 0.01) and metastatic neuroblastoma excluding stage MS (HR = 0.61, 95% CI 0.44-0.84; p < 0.01).These results indicate that improvements in childhood cancer survival in Australia are most likely due to refined management rather than changes in stage at diagnosis, particularly for metastatic solid tumours. Wide international uptake of the Toronto Guidelines will allow comprehensive evaluation of differences in survival between countries.