Survival Impact of Surgery, Radiation, and Socioeconomic Factors in Spinal Hemangioblastoma: A Population-Based Study

Spinal hemangioblastomas are rare, highly vascular benign tumors, with management typically centered on gross total resection. However, factors associated with overall survival (OS) remain poorly defined, particularly the roles of surgical extent, radiation therapy (RT), and socioeconomic variables. We aimed to evaluate clinical and demographic predictors of survival in a contemporary population-based cohort.

Patients with spinal cord or cauda equina hemangioblastoma were identified from the Surveillance, Epidemiology and End Results database (1975-2022). Demographic, tumor, and treatment characteristics-including age, sex, race, income, surgical extent, and RT-were collected. Univariable and multivariable Cox proportional hazards models were used to evaluate associations with OS.

Among 223 patients, older age (P<0.001) and lower household income (P=0.028) were independently associated with worse survival. Extent of resection (subtotal resection or observation vs. gross total resection) and RT were not significantly associated with OS (P=0.117). Kaplan-Meier analysis showed no survival difference by surgery (P=0.89) or between pediatric and adult patients (P=0.1), with all pediatric patients alive at last follow-up. Although RT correlated with worse survival on univariate analysis (P=0.005), this did not persist after adjustment, likely reflecting confounding by indication.

Older age and lower income were associated with worse OS in patients with spinal hemangioblastoma, while neither surgical extent nor RT predicted survival. These findings suggest that subtotal resection or observation may be appropriate in select cases without compromising outcomes and emphasize the importance of addressing socioeconomic barriers in this rare, benign disease.