Research Article: The association between race and survival in glioblastoma patients in the US: A retrospective cohort study

Date Published: June 21, 2018

Publisher: Public Library of Science

Author(s): Andrew Bohn, Alexander Braley, Pura Rodriguez de la Vega, Juan Carlos Zevallos, Noël C. Barengo, Tomi F. Akinyemiju.

http://doi.org/10.1371/journal.pone.0198581

Abstract

Glioblastoma is the most common primary brain cancer in adults with an incidence of 3.4 per 100,000, making up about 15% of all brain tumors. Inconsistent results have been published in regard differences in survival between white and black glioblastoma patients. The objective of this to study the association between race and in Glioblastoma patients in the USA during 2010–2014.

The National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) database were used to evaluate race/ethnicity (White non-Hispanic, Black non-Hispanic, Asian/Pacific Islanders non-Hispanic (API)) and Hispanic) adults patients with first-time diagnosis of glioblastoma (International Classification of Diseases for Oncology, 3rd Edition [ICD-O-3], codes C711-C714, and histology type 9440/3) from 2010–2014. The primary outcome was 3-year overall survival which was defined as months from diagnosis to death due to any cause and cancer, Kaplan-Meier (KM) and log-rank test were used to compare overall survival times across race groups. Cox proportional hazard models were used to determine the independent effect of race on 3-year survival. Age, gender, health insurance coverage, primary site, tumor size, extent of surgery and year of diagnosis were included in the adjusted model. The 3-year overall survival for API-non Hispanic (NH) patients decreased by 25% compared with White NH glioblastoma patients (hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.62–0.90)) after adjusting for age, gender, health insurance, primary site, tumor size, and extent of the surgery. Black NH (HR 0.95; 95% CI 0.80–1.13) and Hispanic (HR 1.01, 95% CI 0.84–1.21) exhibited similar mortality risks compared with White NH patients.

Compared with White NH, API NH with glioblastoma have a better survival. The findings from this study can help increase the accuracy of the prognostic outlook for white, black and API patients with GBM.

Partial Text

Glioblastoma (GBM) is the most common primary brain cancer in adults with an incidence of 3.4 per 100,000, making up about 15% of all brain tumors [1, 2]. Despite advances in surgical and radiotherapy techniques the prognosis of GBM is dismal with a median survival of 12–14 months [1–3]. The current standard of care involves surgical resection along with temozolomide and radiotherapy, which has been shown to improve survival [4].

Among the glioblastoma patients identified, the majority were white (83.2%) and 5.9%, 5.4%, and 5.5% were black NH, API NH and Hispanic respectively. Table 1 presents the baseline characteristics of patients in the US between 2010 and 2014 according to race/ethnicity. We identified significant racial/ethnicity differences in the age at diagnosis, health insurance, and extent of the primary surgery. The mean age at diagnosis was higher for white Non-Hispanic patients compared to non-Hispanic black, and Hispanics (64.4 vs.61.4, and 60.7, p = 0.015, respectively). Blacks NH (23.4%), Hispanics (22.9%) and API NH (18.8%) tended to be younger compared to (whites NH 13.8%). White NH patients were more frequently insured (91.3%), compared to 77.8% of blacks NH, 76.2% of API NH and 76.1% of Hispanic, (p<0.001). White NH and Black NH patients had a higher proportion of gross total resection surgery (37.6% and 37.1% respectively) compared to API NH (25.3%) and Hispanic (24.0%), while API NH had a higher proportion of no surgery (25.7%, p<0.001). Glioblastoma White, Black and Hispanic patients are more likely to die during the first three years after diagnosis (72.3%, 71.2% and 67.7% respectively) compared to API’s (63.4%, p = 0.040). There were not statistically significant difference among race/ethnicity in regards to gender (p = 0.728), primary site (p = 0.208), and tumor size (p = 0.356). This study found that API NH patients have a significantly better survival rate than White NH after controlling for age, gender, health insurance status, site, tumor size and extent of surgery. No significant differences in glioblastoma survival were observed among Black NH and Hispanic compared with White NH.   Source: http://doi.org/10.1371/journal.pone.0198581

 

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