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Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma

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Abstract

Introduction

The prognostic role of racial and socioeconomic factors in patients with glioblastoma is controversially debated. We aimed to evaluate how these factors may affect survival outcomes in an overall and cause-specific manner using large, national cancer registry cohort data in the temozolomide chemoradiation era.

Methods

The National Cancer Institute’s Surveillance, Epidemiology, and End Results database was queried for patients diagnosed with glioblastoma between 2005 and 2016. Overall survival was assessed using Cox proportional hazard models using disease intrinsic and extrinsic factors. Cause-specific mortality was assessed using cumulative incidence curves and modeled using multivariate cumulative risk regression.

Results

A total of 28,952 patients met the prespecified inclusion criteria and were included in this analysis. The following factors were associated with all-cause mortality: age, calendar year of diagnosis, sex, treatment receipt, tumor size, tumor location, extent of resection, median household income, and race. Asian/Pacific Islanders and Hispanic Whites had lower mortality compared to Non-Hispanic Whites. Cause-specific mortality was associated with both racial and socioeconomic groups. After adjusting for treatment and tumor-related factors, Asian/Pacific and black patients had lower glioblastoma-specific mortality. However, lower median household income and black race were associated with significantly higher non-glioblastoma mortality.

Conclusions

Despite the aggressive nature of glioblastoma, racial and socioeconomic factors influence glioblastoma-specific and non-glioblastoma associated mortality. Our study shows that patient race has an impact on glioblastoma-associated mortality independently of tumor and treatment related factors. Importantly, socioeconomic and racial differences largely contribute to non-glioblastoma mortality, including death from other cancers, cardio- and cerebrovascular events.

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Data availability

The data used in this study are derived from a de-identified SEER file and are provided free of charge upon request.

Code availability

The code used in this study is available on request to the corresponding author.

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Authors and Affiliations

  1. Brain and Spine Tumor Center, Laura and Isaac Perlmutter Cancer Center at NYU Langone Health, 240 E 38th Street, 19th Floor, New York, NY, USA

    Elisa K. Liu, Sharon Yu, Erik P. Sulman & Sylvia C. Kurz

  2. New York University Grossman School of Medicine, New York, NY, USA

    Elisa K. Liu

  3. Cornell University, Ithaca, NY, USA

    Sharon Yu

  4. Department of Radiation Oncology, New York University Grossman School of Medicine, New York, NY, USA

    Erik P. Sulman

  5. Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA

    Sylvia C. Kurz

Authors
  1. Elisa K. Liu
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  2. Sharon Yu
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  4. Sylvia C. Kurz
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Correspondence to Sylvia C. Kurz.

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Liu, E.K., Yu, S., Sulman, E.P. et al. Racial and socioeconomic disparities differentially affect overall and cause-specific survival in glioblastoma. J Neurooncol 149, 55–64 (2020). https://doi.org/10.1007/s11060-020-03572-y

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  • DOI: https://doi.org/10.1007/s11060-020-03572-y

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