Socioeconomic and clinical characteristics of large cell medulloblastoma: A comprehensive NCDB study.

Abstract

e14040 Background: Large cell medulloblastoma (LCMB) is a rare and aggressive subtype of medulloblastoma, marked by large pleomorphic tumor cells typically located in the cerebellum. Approximately 43% of LCMB patients present with cerebrospinal fluid dissemination at diagnosis, reflecting the malignancy's propensity for early spread. Often associated with TP53 mutations, LCMB is more common in adults than typical medulloblastomas, which predominantly affect children. It is commonly treated through surgical resection, radiation therapy, and chemotherapy. This study aims to bridge the gap in knowledge surrounding LCMB by analyzing demographic, socioeconomic, and clinical factors using data from the National Cancer Database (NCDB). Methods: A retrospective cohort study utilized data from the 2004-2020 National Cancer Database (NCDB), encompassing 229 patients with a histologically confirmed diagnosis of Large Cell Medulloblastoma (ICD-O-3 code 9474). Various demographic variables (age, sex, race, Hispanic status, educational attainment, insurance status, facility type, distance from facility, and Charles/Deyo score) were examined through descriptive statistical methods. Trends in cancer incidence were further assessed using a regression analysis. Results: LCMB is more common in males (66.5%), with a high incidence in white (79.6%) and non-Hispanic individuals (76.3%). More patients were treated in Academic/Research Programs (50.0%) compared to Integrated Network Cancer Programs (28.6%) and Comprehensive Community Cancer Programs (21.4%). The majority of patients resided in metropolitan areas with populations over 1 million (51.9%) and had household incomes over $74,063 (41.0%). Private Insurance/Managed Care covered 59.2% of patients, while 31.0% were covered by Medicaid. Surgical resection was performed in 97.6% of cases, and surgical margin data were missing for 97.6%. Primary treatment modalities included radiation therapy (74.3%) and chemotherapy (71.4%). The mean tumor size was 56.3 mm, with 74.7% of tumors located in the cerebellum. Survival rates were 69.8% at 2 years, 60.7% at 5 years, and 51.2% at 10 years, with a mean overall survival of 116.7 months. Conclusions: This study offers one of the first NCDB-based analyses of LCMB, shedding light on key demographic and socioeconomic trends. The majority of LCMB patients were non-Hispanic white and resided in high-income metropolitan areas. Additionally, most were treated in academic centers, with radiation therapy and chemotherapy as the primary treatments. These findings emphasize the need for further research on the impact of socioeconomic factors on diagnosis, treatment access, and long-term survival outcomes, particularly in underserved and minority populations. Future studies should focus on addressing the gaps in surgical treatment and exploring the role of targeted therapies in improving patient outcomes.