Pediatric Intramedullary Spinal Cord Tumors: A National Cancer Database Analysis of Demographics, Treatment, and Survival Outcomes

Introduction: Intramedullary spinal cord tumors (IMSCTs) in pediatric patients are rare neoplasms. Our study seeks to analyze a large cohort of pediatric patients from the National Cancer Database (NCDB) with IMSCTs to determine patient demographics, treatment patterns and associated outcomes of this cohort.

Methods: The NCDB was queried from 2004 to 2018 for pediatric (aged ≤ 21) patients diagnosed with histologically confirmed IMSCTs (astrocytoma, ependymoma, and hemangioblastoma). Data regarding sociodemographics, tumor characteristics, and treatment modalities were extracted. The primary outcome of interest was overall survival (OS), which was evaluated for using univariate and multivariate Cox proportional hazard models along with associated survival curves and Kaplan–Meier analyses. Secondary outcomes of interest included utilization of treatment modalities (surgery, radiotherapy and chemotherapy) and early postoperative outcomes (prolonged length of stay and unplanned readmissions) for patients who underwent surgical interventions. These secondary outcomes were evaluated with univariate and multivariate logistic regression models.

Results: Our cohort of 1066 patients had a median age at diagnosis of 15 years. Six hundred thirty-three (59.4%) were male, 853 (83.1%) were white, and 904 (84.8%) lacked any comorbidities. There were 928 (87.1%) treated by surgery, 259 (24.7%) treated by radiotherapy, and 120 (11.45%) treated by chemotherapy. 1-, 5-, and 10-year overall survival rates were 97.3% [95% confidence interval (CI), 96.3%-98.3%), 92.5% (95% CI, 90.8%-94.2%), and 89.7% (95% CI, 87.4% -91.9%). Multivariable analysis demonstrated that age category of 6-10 [hazard ratio (HR) = 2.65, p=0.015), of 11-15 (HR=2.75, p=0.012), of 16-21 (HR=2.74, p=0.018), black race (HR=2.28, p=0.008), rural residence (HR=4.42, p=0.048), astrocytoma histology (HR=2.21, p=0.003), radiotherapy (HR=3.58, p< 0.001), and chemotherapy (HR=4.83, p< 0.001) independently predicted shorter OS.

Conclusion : These data show long-term survival outcomes for pediatric patients with IMSCTs. Sociodemographic variables were associated with both survival outcomes and utilization of treatment modalities. These findings underline disparities in healthcare utilization among this patient population.