Racial and socioeconomic disparities in glioblastoma outcomes: A single-center, retrospective cohort study
Menée aux Etats-Unis à partir de données portant sur 995 patients atteints d'un glioblastome, cette étude de cohorte rétrospective analyse la survie en fonction de l'origine ethnique et du niveau socioéconomique
Background : Glioblastoma (GBM) is the most common malignant primary brain tumor. Emerging reports have suggested that racial and socioeconomic disparities influence the outcomes of patients with GBM. No studies to date have investigated these disparities controlling for isocitrate dehydrogenase (IDH) mutation and O-6-methylguanine-DNA methyltransferase (MGMT) status. Methods : Adult patients with GBM were retrospectively reviewed at a single institution from 2008 to 2019. Univariable and multivariable complete survival analyses were performed. A Cox proportional hazards model was used to assess the effect of race and socioeconomic status controlling for a priori selected variables with known relevance to survival. Results : In total, 995 patients met inclusion criteria. Of these, 117 patients (11.7%) were African American (AA). The median overall survival for the entire cohort was 14.23 months. In the multivariable model, AA patients had better survival compared with White patients (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.2–0.69). The observed survival difference was significant in both a complete case analysis model and a multiple imputations model accounting for missing molecular data and controlling for treatment and socioeconomic status. AA patients with low income (HR, 2.17; 95% CI, 1.04–4.50), public insurance (HR, 2.25; 95% CI, 1.04–4.87), or no insurance (HR, 15.63; 95% CI, 2.72–89.67) had worse survival compared with White patients with low income, public insurance, or no insurance, respectively. Conclusions : Significant racial and socioeconomic disparities were identified after controlling for treatment, GBM genetic profile, and other variables associated with survival. Overall, AA patients demonstrated better survival. These findings may suggest the possibility of a protective genetic advantage in AA patients.
Cancer 2023