Pediatric central nervous system tumors: An analysis of patients treated at Children's Nebraska over a 10-year period

Nebraska has consistently had rates of pediatric Central Nervous System Neoplasms (CNS) above the national average. The study was an exploratory analysis using clinical data to characterize pediatric CNS tumors treated at Children's Nebraska or Nebraska Medicine over a 10-year period. Electronic health records were reviewed to identify patients diagnosed with a CNS tumor, aged 0 to 18 years, and treated at Children's Nebraska or Nebraska Medicine from 2013 to 2023. Data collected included demographics, clinical characteristics, and genetic testing information. ICD-0-3 codes were used to identify patients with a CNS tumor diagnosis. Diagnoses were classified according to the 2016 World Health Organization (WHO) Classification of Tumors. Zip codes were used to identify the Rural Urban Continuum Code (RUCC) of the patient's county of residence to determine urbanicity. The study population characteristics were summarized and descriptively compared by urbanicity, with chi-squared testing to determine significance. A total of 172 patients aged 0 to 18 years were identified as being diagnosed with a primary central nervous system tumor between 2013 to 2023. A greater proportion of patients were diagnosed at a younger age, with a median age at diagnosis of 7 years. The study population was predominantly female (55.81%; n=96), alive (77.33%; n=133), non-Hispanic White (72.09%; n=124), and from a metropolitan area (70.93%; n=122). Considering tumor characteristics, most diagnoses were malignant (87.21%; n=150) and made at the local stage (96.49%; n=165). Gliomas were the most diagnosed (65.12%; n=112) followed by embryonal tumors (16.86%; n=29). Tumor locations were predominantly reported as the brain stem (22.67%; n=39) or cerebellum (21.51%; n=37). Genetic testing data was available for 40 patients. The most affected gene was KIAA1549-BRAF (14.29%; n=6) and the most common gene effect was fusion (28.13%; n=9). Stratification by RUCC revealed minimal variations in the demographic and clinical characteristics between metropolitan and non-metropolitan areas. The proportion of malignant diagnoses, however, was higher non-metropolitan areas than metropolitan areas (p = 0.0271). Given the relative rarity of pediatric CNS tumors, data over an extended time period are required to accurately describe the disease and the population in which it occurs. In this analysis, we described the population of pediatric CNS tumor patients treated at Children's Nebraska and Nebraska Medicine. These methods can be expanded to include additional diagnostic years, clinical characteristics, or predictors, such as environmental exposures to gain a better understanding of the trends in pediatric CNS tumors.