ID #1097 Surgical non-treatment as a predictor of survival in pediatric malignant brain tumors: a population-based analysis
Maryam Shaaban, Carolina Teixeira Salgado Pinto Lopes, Emily Distler, Alfred Wong, Amirali Mons, Ankit MehtaAbstract
Introduction
Malignant brain tumors are the leading cause of cancer-related mortality in pediatric patients, and surgical intervention is often a critical component of treatment. This database analysis evaluates outcomes associated with differential decision-making.
Methods
The National Cancer Database (NCDB) was queried for patients aged 0 to 24 years diagnosed with a malignant brain tumor from 2000 to 2022. Patients were separated into two groups: those who had surgery and those whose surgeons recommended surgery but did not receive it. Pearson’s chi-square test and the Wilcoxon rank-sum test were used to compare groups. A multivariate model was used to determine the effects of patient demographics and tumor characteristics on the decision to undergo surgery. R Studio (version 2025.09.1 + 401) was used for data analysis.
Results
Of 7,532 patients, 7,404 (98.3%) underwent surgery, while 128 (1.7%) refused. Kaplan-Meier analysis showed that patients who refused surgery had significantly lower survival rates (p = 0.0046). The multivariate model showed that parents of infants were more likely to refuse surgery (1-4 years: OR = 0.29, p = 0.009; 5-9 years: OR = 0.38, p = 0.032; 10-14 years: OR = 0.30, p = 0.011; 15-19 years: OR = 0.35, p = 0.023). Brainstem tumors were not associated with surgery (p > 0.05).
Discussion
Our analysis showed improved survival outcomes among patients who underwent the recommended surgery.
Conclusion
Surgical non-performance has distinct survival profiles. Our findings identifytargets for care-pathway improvement.