Abstract

Background

How pediatric medulloblastoma patients fare in Lower Middle-Income Country (LMICs) in South America is not well understood. Correspondingly, the aim of this study was to summarize the pediatric neurosurgical experience of an institution in La Paz, and compare outcomes to that of a generalized High Income Country (HIC) United States (US) experience.

Methods

A retrospective review of all pediatric neurosurgical medulloblastoma patients at the Children’s Hospital of La Paz, Bolivia (Hospital del Niño “Dr. Ovidio Aliaga Uria”) between 2014 and 2023 was conducted and compared to a generalized US experience abstracted from the US National Cancer Database (NCDB) and National Inpatient Sample (NIS) databases. Categorical, continuous and survival data were statistically summarized and compared.

Results

A total of 24 pediatric medulloblastoma patients underwent neurosurgical treatment at the Hospital del Niño. In this La Paz cohort, there were 15 (63%) males and 9 (38%) females, with a mean age of 5.6 years old at diagnosis. The majority of patients underwent subtotal resection (STR, 79%), while the remaining patients underwent biopsy only. Ten (42%) patients expired during their hospitalization, and mean length of stay overall was 39 days. Only 8 (33%) patients received adjuvant treatment after surgery. Median overall survival from diagnosis in the La Paz cohort was 1.9 months. Compared to the US databases, the La Paz cohort experienced significantly more emergency room admissions for surgery, less gross total resection, more STR, more return to operating room for ventriculoperitoneal shunting, more bacteremia, more tracheostomy procedures, more percutaneous gastrostomy placements, longer lengths of stay, less adjuvant chemotherapy, less radiation therapy, shorter follow-up, and ultimately, significantly shorter overall survival (all P < 0.050).

Conclusions

Pediatric neurosurgical medulloblastoma outcomes at the Children’s Hospital of La Paz, Bolivia are significantly inferior to that of a generalized US experience. Future research is required to identify institution- and country-specific initiatives to improve discrepancies between institutions in LMICs in South America compared to HICs.

中文翻译：

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玻利维亚拉巴斯的小儿神经外科髓母细胞瘤结果：南美洲中低收入国家 (LMIC) 机构与美国的比较

摘要

背景

南美洲中低收入国家 (LMIC) 儿童髓母细胞瘤患者的情况尚不清楚。相应地，本研究的目的是总结拉巴斯一家机构的儿科神经外科经验，并将结果与​​美国高收入国家 (HIC) 的经验进行比较。

方法

对 2014 年至 2023 年间玻利维亚拉巴斯儿童医院（Hospital del Niño“Dr. Ovidio Aliaga Uria”）所有儿科神经外科髓母细胞瘤患者进行了回顾性审查，并与从美国国家癌症数据库中摘录的一般美国经验进行了比较(NCDB) 和国家住院样本 (NIS) 数据库。对分类数据、连续数据和生存数据进行统计总结和比较。

结果

共有 24 名儿童髓母细胞瘤患者在德尔尼诺医院接受了神经外科治疗。在拉巴斯队列中，有 15 名男性 (63%) 和 9 名女性 (38%)，诊断时平均年龄为 5.6 岁。大多数患者接受了次全切除（STR，79%），而其余患者仅接受了活检。 10 名 (42%) 患者在住院期间死亡，平均住院时间为 39 天。只有8名（33%）患者在术后接受了辅助治疗。拉巴斯队列中诊断后的中位总生存期为 1.9 个月。与美国数据库相比，拉巴斯队列因手术进入急诊室的人数显着增加，肉眼全切除术减少，STR增加，返回手术室进行脑室腹腔分流术的次数增加，菌血症增加，气管切开手术次数增多，经皮胃造口术放置次数增多，长度更长住院时间、更少的辅助化疗、更少的放射治疗、更短的随访时间，最终显着缩短总生存期（所有P  < 0.050）。

结论

玻利维亚拉巴斯儿童医院的小儿神经外科髓母细胞瘤结果明显低于美国的普遍经验。未来的研究需要确定针对机构和国家的具体举措，以改善南美洲中低收入国家与高收入国家机构之间的差异。