Desmoplastic nodular medulloblastoma: A National Cancer Database analysis of patient demographics and survival.

Abstract

e14041 Background: Desmoplastic/nodular medulloblastoma (DNMB) is a subtype of primary brain tumor characterized by its distinctive nodular architecture and dense fibrous tissue formation within the cerebellum. DNMB accounts for up to 61% of medulloblastoma diagnoses in infants under 3 years and demonstrates one-third better survival compared to classical medulloblastoma. However, its distinct clinical patterns remain largely unexplored. Current literature predominantly focuses on combined medulloblastoma subtypes, with DNMB-specific analyses often merged into broader outcome studies. The lack of large-scale studies on DNMB's unique demographic and clinical patterns represents a critical gap in neuro-oncology. This study fills that gap with the first comprehensive NCDB analysis, focusing solely on DNMB to identify its distinct patterns and characteristics. Methods: This investigation employed the National Cancer Database (NCDB) to conduct a population-based analysis of patients diagnosed with DNMB (ICD-O-3 code 9471) between 2004 and 2020. Patient characteristics, including demographic information (age, sex, race, ethnicity), socioeconomic indicators (education level, insurance coverage), healthcare access factors (facility type, travel distance), and comorbidity indices were evaluated using statistical analysis of trends and distributions. Results: Among 811 patients with DNMB, the majority were male (59.4%), white (78.1%), and non-Hispanic (78.4%). Patients were treated at Academic/Research Programs (43.8%), Comprehensive Community Cancer Programs (30.1%), and Integrated Network Cancer Programs (26.0%). Geographically, the Pacific (23.3%) and South Atlantic (21.9%) regions had the highest case distribution. Most patients were insured by Private Insurance/Managed Care (57.0%) and lived in metropolitan areas (54.7%). Regarding education status, 28.4% came from areas with 9.1%-15.2% of adults without a high school diploma, indicating moderate educational disadvantage. Economically, 36.4% resided in areas with median household incomes over $74,063. Additionally, 84.7% had tumors in the cerebellum, and the Charlson-Deyo comorbidity score was 0 for 94.6%. Survival rates were 91.1% at 2 years, 84.8% at 5 years, and 75.2% at 10 years. Treatment included surgery (97.8 %), radiation (71.9%), and chemotherapy (73.7%). Conclusions: This study provides the first in-depth analysis of DNMB using the NCDB. The findings show that DNMB predominantly affects male, white, non-Hispanic patients, often diagnosed in metropolitan areas and treated in academic or community settings. Socioeconomic factors, such as higher income and education, were overrepresented. Survival rates were promising, but further research is needed to understand how demographic, socioeconomic, and clinical factors influence DNMB outcomes.