Neurosurgical Outcomes for Pediatric Central Nervous System Tumors in the United States

Abstract

BACKGROUND:Limited data exist on pediatric central nervous system (CNS) tumors, and the results from the National Cancer Database, the largest multicenter national cancer registry, have not previously been comprehensively reported.OBJECTIVE:To capture pediatric neurosurgical outcomes and investigate possible disparities of care.METHODS:The National Cancer Database was queried for pediatric patients who were diagnosed with CNS tumors from 2004 to 2018. Primary outcomes included 30/90 days postoperative mortality (30M/90M), readmission within 30 days of discharge (30R), and length of inpatient stay (LOS).RESULTS:Twenty four thousand nine hundred thirty cases met the inclusion criteria, of which were 4753 (19.1%) juvenile pilocytic astrocytomas, 3262 (13.1%) medulloblastomas, 2200 (8.8%) neuronal/mixed neuronal-glial tumors, and 2135 (8.6%) ependymal tumors. Patients aged 0 to 4 years had significantly poorer outcomes than patients in older age groups (90M: 3.5% vs 0.7%-0.9%; 30R: 6.5% vs 3.6%-4.8%; LOS: 12.0 days vs 6.0-8.9 days). Tumor size was a strong predictor of poor outcomes with each additional cm in diameter conferring a 26%, 7%, and 23% increased risk of 90M, 30R, and prolonged LOS, respectively. Data over the study period demonstrated year over year improvements of 4%, 3%, and 2%, respectively, for 90M, 30R, and prolonged LOS. Facilities with a high volume of pediatric tumor cases had improved 90M (1.1% vs 1.5%, P = .041) and LOS (7.6 vs 8.6 days, P < .001). Patients with private health insurance had better outcomes than patients with government insurance.CONCLUSION:There is substantial variability in surgical morbidity and mortality of pediatric CNS tumors. Additional investigation is warranted to reduce outcome differences that may be based on socioeconomic factors.

In Reply: Neurosurgical Outcomes for Pediatric Central Nervous System Tumors in the United States

“…We appreciate the thoughtful response to our article by Lu et al, which provides important context for our work and notes additional limitations of the National Cancer Database (NCDB) Analyses. 1,2 We completely agree that future studies with greater granularity would be valuable for improving patient prognostication and care equity. It is important to note that our study was designed as a statistical report intended to outline broad treatment trends and outcomes within the pediatric central nervous system tumor population.…”

Oncologia e Hematologia - Edição VI

“…Os dados também demonstraram as vantagens da ressonância magnética intraoperatória para tumores pediátricos e tumores da fossa posterior. No entanto, faltam dados relativos à ressonância magnética intraoperatória, especialmente para a ressecção de meduloblastomas, mas parece sensato reali-zar imagens intraoperatórias para aumentar a qualidade cirúrgica e a segurança do paciente durante a ressecção do tumor (CHALIF et al, 2023).…”

Letter: Neurosurgical Outcomes for Pediatric Central Nervous System Tumors in the United States

“…We read with great interest the recently published article by Chalif et al 1 in which they provide a scoping review of socioeconomic parameters affecting pediatric outcomes for all central nervous system (CNS) tumors in the National Cancer Database (NCDB). The need to better define neurosurgical success in pediatric CNS tumors is crucial to this field, and the authors are commended for addressing this important issue.…”

“…Ultimately, the results of this NCDB study by Chalif et al 1 stoke the fire for more robust data to identify and implement sociodemographically oriented initiatives to homogenize care and outcomes for pediatric patients with CNS tumors. It highlights the need for greater granularity in prospective efforts designed to obtain future data, as currently the ambiguity and paucity of many elements of care affects the generalizability of these results to modern practice.…”