Differences in Survival Among Infantile, Pediatric and Adult Intracranial Medulloblastoma: A SEER Analysis

Abstract

Objective

Survival differences in infantile, paediatric, and adult medulloblastoma are unclear. This study aims to determine the difference in the overall survival among infant, pediatric and adult intracranial medulloblastomas and its associated factors

Methods

The National Cancer Institute-Surveillance, Epidemiology and End Results (SEER) database was queried for medulloblastoma from 2000 to 2020 using International Classification of Disease(ICD) for Oncology, with morphology codes 9470-9477/3. Age groups were divided into infantile (<3years old), paediatric (3-18years old) and adult (>18 years old). Rates of dying among infantile and adult medulloblastoma were compared to the rate among pediatric medulloblastomas. Chi-squared test was used for categorical variable. Cox-proportional analysis was used, Kaplan-Meier survival curves were generated for the three cohorts and log rank test was performed.

Results

1,991 patients were included: infantile(372,18.68%), paediatric(1,026,51.53%) and adult(593,29.78%) medulloblastoma. The 3-year overall survival (OS) were 69.81%, 84.62%, 83.45%; the 5-year OS were 66.65%, 79.46%,76.45%; and the 10-year OS were 63.67%, 72.38% and 66.89% respectively for infantile, pediatric and adult medulloblastoma. Regional and distant disease, large cell medulloblastoma, less than complete surgery, non-receipt of radiotherapy and chemotherapy were associated with higher rate of dying. 297 patients were treated with chemotherapy but not radiotherapy, with majority (220, 74.07%) being infantile medulloblastoma. 216 (36%) of the adult medulloblastoma did not receive any chemotherapy. Less than 5% had molecular classification reported.

Crude hazard ratio(HR) of infantile compared to paediatric medulloblastoma is 1.65 (95%CI:1.33-2.04). After adjusting for gender, histology/molecular subtyping and receipt of radiotherapy, the HR decreased to 1.29(95%CI:1.01-1.66). Crude HR of adult compared to pediatric medulloblastoma is 1.24(95%CI:1.02-1.51). After adjusting for gender, histology/molecular subtyping and receipt of chemotherapy, the HR decreased to 1.10(95%CI:0.89-1.37).

Conclusion

There is a survival difference among infantile, paediatric and adult medulloblastoma. The difference appeared to decrease when adjusted for the treatment and biology.