Treatment advancements in pediatric cancer have improved prognosis, but the strength of supporting evidence has not been thoroughly evaluated. To critically appraise it, we performed an umbrella review of meta-analyses of randomized controlled trials examining the efficacy and safety of therapeutic interventions for pediatric malignancies. Fourteen publications (68 meta-analyses, 31,496 participants) were eligible. Acute lymphoblastic leukemia (ALL) was investigated at most. Substantial heterogeneity was detected in 10 associations, with limited indications for small-study effects and excess-significance bias. The most concrete evidence pertained to the use of methotrexate and vincristine-prednisone pulses for ALL, improving event-free survival. Evidence regarding other cancers was relatively weak. Conclusively, we found few small meta-analyses focusing mainly on ALL. Randomized evidence stemming from adult populations still seems to serve as valuable indirect evidence backup. More randomized evidence and individual patient data meta-analyses are needed to increase certainty and precision in the care of pediatric cancer patients.

儿科癌症的治疗进展改善了预后，但支持证据的强度尚未得到彻底评估。为了批判性地评估它，我们对随机对照试验的荟萃分析进行了综合评价，这些试验检查了儿科恶性肿瘤治疗干预的有效性和安全性。14 篇出版物（68 篇荟萃分析，31,496 名参与者）符合条件。最多研究急性淋巴细胞白血病（ALL）。在 10 个关联中检测到显着的异质性，小型研究效应和超显着性偏倚的适应症有限。最具体的证据涉及使用甲氨蝶呤和长春新碱强的松脉冲治疗 ALL，提高无事件生存率。关于其他癌症的证据相对较弱。最终，我们发现很少有小型荟萃分析主要关注 ALL。来自成年人口的随机证据似乎仍然可以作为有价值的间接证据支持。需要更多随机证据和个体患者数据荟萃分析，以提高儿科癌症患者护理的确定性和精确性。