Epidemiologic Trends and Long-term Survival Predictors of Spinal Hemangioblastomas: A National Cancer Database (NCDB) Study

Introduction: Spinal hemangioblastomas are benign intradural intramedullary tumors of the spinal cord. These tumors can exhibit aggressive growth and invasion of neighboring structures, and their treatment usually involves surgery, chemotherapy, or radiotherapy. We aim to investigate epidemiologic trends, treatment modalities, and overall survival in patients diagnosed with spinal hemangioblastomas and to determine the predictors impacting survival and postoperative length of stay (LOS).

Methods: We queried the National Cancer Database from 2004 to 2016 for patients diagnosed with spinal hemangiomas. Demographic, clinical, and outcomes data were compiled. Five-year survival for each treatment was compared using the Kaplan-Meier (KM) and Nelson-Aalen (NA) curves with statistical comparisons based on the log-rank test. Multivariate analysis was performed to determine survival determinants. Supervised machine learning (ML) models were trained to predict survival and model performance was evaluated. Shapley additive explanations (SHAP) were calculated using the best-performing model for feature importance.

Results: A total of 798 patients diagnosed with spinal cord hemangioblastoma were analyzed. The most common treatment was surgical resection (N=687), followed by radiotherapy (N=67) and surgery combined with radiotherapy (N=50).Age (p < 0.01), a Charlson comorbidity score (CDCC) of 2 or 3 (p=0.04; p=0.025), tumor size (p < 0.01), and chemotherapy alone (p < 0.01) are more likely to predict mortality. Surgical resection alone (p=0.02) was less likely to predict mortality. The best performing ML model was Random Forest (99.9%). Increased odds of survival are associated with surgery alone or surgery with radiotherapy (p < 0.05). SHAP showed that age, year of diagnosis, and days until radiation therapy have the highest impact on survival. CDCC of 2; Medicare or private insurance are more likely to predict post-operative LOS.

Conclusion : This study provides the most comprehensive description of the epidemiologic, treatment, and survival trends of hemangioblastomas. Our analysis demonstrates that surgical resection, either alone or coupled with radiotherapy, significantly improves long-term survival.