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Erschienen in: Journal of Neuro-Oncology 2/2019

13.04.2019 | Clinical Study

Racial/ethnic differences in survival for patients with gliosarcoma: an analysis of the National cancer database

verfasst von: James M. Wright, Tiffany R. Hodges, Christina Huang Wright, Haley Gittleman, Xiaofei Zhou, Kelsey Duncan, Carol Kruchko, Andrew Sloan, Jill S. Barnholtz-Sloan

Erschienen in: Journal of Neuro-Oncology | Ausgabe 2/2019

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Abstract

Purpose

Gliosarcoma is characterized by the World Health Organization as a Grade IV malignant neoplasm and a variant of glioblastoma. The association of race and ethnicity with survival has been established for numerous CNS malignancies, however, no epidemiological studies have reported these findings for patients with gliosarcoma. The aim of this study was to examine differences by race and ethnicity in overall survival, 30-day mortality, 90-day mortality, and 30-day readmission.

Methods

Data were obtained by query of the National Cancer Database (NCDB) for years 2004–2014. Patients with gliosarcoma were identified by International Classification of Diseases for Oncology, Third Edition (ICD-O-3)—Oncology morphologic code 9442/3 and topographical codes C71.0–C71.9. Differences in survival by race/ethnicity were examined using univariable and multivariable Cox proportional hazards models. Readmission and mortality outcomes were examined with univariable and multivariable logistic regression.

Results

A total of 1988 patients diagnosed with gliosarcoma were identified (White Non-Hispanic n = 1,682, Black Non-Hispanic n = 165, Asian n = 40, Hispanic n = 101). There were no differences in overall survival, 30- and 90-day mortality, or 30-day readmission between the races and ethnicities examined. Median survival was 10.4 months for White Non-Hispanics (95% CI 9.8, 11.2), 10.2 months for Black Non-Hispanics (95% CI 8.6, 13.1), 9.0 months for Asian Non-Hispanics (95% CI 5.1, 18.2), and 10.6 months for Hispanics (95% CI 8.3,16.2). 7.3% of all patients examined had an unplanned readmission within 30 days.

Conclusion

Race/ethnicity are not associated with differences in overall survival, 30-day mortality, 90-day mortality, or 30-day readmission following surgical intervention for gliosarcoma.
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Literatur
1.
Zurück zum Zitat Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS (2018) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011-2015. Neuro Oncol 20(suppl_4):iv1–iv86CrossRefPubMed Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS (2018) CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011-2015. Neuro Oncol 20(suppl_4):iv1–iv86CrossRefPubMed
2.
Zurück zum Zitat Kruchko C, Ostrom QT, Gittleman H, Barnholtz-Sloan JS (2018) The CBTRUS story: providing accurate population-based statistics on brain and other central nervous system tumors for everyone. Neuro Oncol 20(3):295–298CrossRefPubMedPubMedCentral Kruchko C, Ostrom QT, Gittleman H, Barnholtz-Sloan JS (2018) The CBTRUS story: providing accurate population-based statistics on brain and other central nervous system tumors for everyone. Neuro Oncol 20(3):295–298CrossRefPubMedPubMedCentral
3.
Zurück zum Zitat Kozak KR, Mahadevan A, Moody JS (2009) Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol 11(2):183–191CrossRefPubMedPubMedCentral Kozak KR, Mahadevan A, Moody JS (2009) Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol 11(2):183–191CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Galanis E, Buckner JC, Dinapoli RP et al (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: north central cancer treatment group results. J Neurosurg 89(3):425–430CrossRefPubMed Galanis E, Buckner JC, Dinapoli RP et al (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: north central cancer treatment group results. J Neurosurg 89(3):425–430CrossRefPubMed
5.
Zurück zum Zitat Han SJ, Yang I, Ahn BJ et al (2010) Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients. Cancer 116(5):1358–1366CrossRefPubMed Han SJ, Yang I, Ahn BJ et al (2010) Clinical characteristics and outcomes for a modern series of primary gliosarcoma patients. Cancer 116(5):1358–1366CrossRefPubMed
6.
Zurück zum Zitat Rath GK, Sharma DN, Mallick S et al (2015) Clinical outcome of patients with primary gliosarcoma treated with concomitant and adjuvant temozolomide: a single institutional analysis of 27 cases. Indian J Cancer 52(4):599–603CrossRefPubMed Rath GK, Sharma DN, Mallick S et al (2015) Clinical outcome of patients with primary gliosarcoma treated with concomitant and adjuvant temozolomide: a single institutional analysis of 27 cases. Indian J Cancer 52(4):599–603CrossRefPubMed
7.
8.
Zurück zum Zitat Zhang G, Huang S, Zhang J, Wu Z, Lin S, Wang Y (2016) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: a clinical study in Chinese patients. J Neurooncol 127(2):355–362CrossRefPubMed Zhang G, Huang S, Zhang J, Wu Z, Lin S, Wang Y (2016) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: a clinical study in Chinese patients. J Neurooncol 127(2):355–362CrossRefPubMed
10.
Zurück zum Zitat Frandsen J, Orton A, Jensen R et al (2018) Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database. J Neurosurg 128(4):1133–1138CrossRefPubMed Frandsen J, Orton A, Jensen R et al (2018) Patterns of care and outcomes in gliosarcoma: an analysis of the National Cancer Database. J Neurosurg 128(4):1133–1138CrossRefPubMed
11.
Zurück zum Zitat Barnholtz-Sloan JS, Sloan AE, Schwartz AG (2003) Racial differences in survival after diagnosis with primary malignant brain tumor. Cancer 98(3):603–609CrossRefPubMed Barnholtz-Sloan JS, Sloan AE, Schwartz AG (2003) Racial differences in survival after diagnosis with primary malignant brain tumor. Cancer 98(3):603–609CrossRefPubMed
12.
Zurück zum Zitat Barnholtz-Sloan JS, Williams VL, Maldonado JL et al (2008) Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg 108(4):642–648CrossRefPubMed Barnholtz-Sloan JS, Williams VL, Maldonado JL et al (2008) Patterns of care and outcomes among elderly individuals with primary malignant astrocytoma. J Neurosurg 108(4):642–648CrossRefPubMed
13.
Zurück zum Zitat Chakrabarti I, Cockburn M, Cozen W, Wang YP, Preston-Martin S (2005) A population-based description of glioblastoma multiforme in Los Angeles County, 1974-1999. Cancer 104(12):2798–2806CrossRefPubMed Chakrabarti I, Cockburn M, Cozen W, Wang YP, Preston-Martin S (2005) A population-based description of glioblastoma multiforme in Los Angeles County, 1974-1999. Cancer 104(12):2798–2806CrossRefPubMed
14.
Zurück zum Zitat Darefsky AS, King JT Jr, Dubrow R (2012) Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of surveillance, epidemiology, and end results registries. Cancer 118(8):2163–2172CrossRefPubMed Darefsky AS, King JT Jr, Dubrow R (2012) Adult glioblastoma multiforme survival in the temozolomide era: a population-based analysis of surveillance, epidemiology, and end results registries. Cancer 118(8):2163–2172CrossRefPubMed
15.
Zurück zum Zitat Ostrom QT, Gittleman H, Fulop J et al (2015) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol. 17(Suppl 4):iv1–iv62CrossRefPubMedPubMedCentral Ostrom QT, Gittleman H, Fulop J et al (2015) CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol. 17(Suppl 4):iv1–iv62CrossRefPubMedPubMedCentral
16.
Zurück zum Zitat Thakkar JP, Dolecek TA, Horbinski C et al (2014) Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomark Prev 23(10):1985–1996CrossRef Thakkar JP, Dolecek TA, Horbinski C et al (2014) Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomark Prev 23(10):1985–1996CrossRef
17.
Zurück zum Zitat Xu H, Chen J, Xu H, Qin Z (2017) Geographic variations in the incidence of glioblastoma and prognostic factors predictive of overall survival in US Adults from 2004-2013. Front Aging Neurosci 9:352CrossRefPubMedPubMedCentral Xu H, Chen J, Xu H, Qin Z (2017) Geographic variations in the incidence of glioblastoma and prognostic factors predictive of overall survival in US Adults from 2004-2013. Front Aging Neurosci 9:352CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Smith DR, Wu CC, Saadatmand HJ et al (2018) Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma. J Neurooncol 137(2):303–311CrossRefPubMed Smith DR, Wu CC, Saadatmand HJ et al (2018) Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma. J Neurooncol 137(2):303–311CrossRefPubMed
19.
Zurück zum Zitat Lerro CC, Robbins AS, Phillips JL, Stewart AK (2013) Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Ann Surg Oncol 20(6):1759–1765CrossRefPubMed Lerro CC, Robbins AS, Phillips JL, Stewart AK (2013) Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Ann Surg Oncol 20(6):1759–1765CrossRefPubMed
20.
Zurück zum Zitat Bohn A, Braley A, Rodriguez de la Vega P, Zevallos JC, Barengo NC (2018) The association between race and survival in glioblastoma patients in the US: a retrospective cohort study. PLoS ONE 13(6):e0198581CrossRefPubMedPubMedCentral Bohn A, Braley A, Rodriguez de la Vega P, Zevallos JC, Barengo NC (2018) The association between race and survival in glioblastoma patients in the US: a retrospective cohort study. PLoS ONE 13(6):e0198581CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Srivastava H, Dewan A, Sharma SK et al (2018) Adjuvant radiation therapy and temozolomide in gliosarcoma: is it enough? Case series of seven patients. Asian J Neurosurg 13(2):297–301CrossRefPubMedPubMedCentral Srivastava H, Dewan A, Sharma SK et al (2018) Adjuvant radiation therapy and temozolomide in gliosarcoma: is it enough? Case series of seven patients. Asian J Neurosurg 13(2):297–301CrossRefPubMedPubMedCentral
22.
Zurück zum Zitat Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS (2018) Adult glioma incidence and survival by race or ethnicity in the United States From 2000 to 2014. JAMA Oncol 4(9):1254–1262CrossRefPubMedPubMedCentral Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS (2018) Adult glioma incidence and survival by race or ethnicity in the United States From 2000 to 2014. JAMA Oncol 4(9):1254–1262CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Brown DA, Himes BT, Kerezoudis P et al (2018) Insurance correlates with improved access to care and outcome among glioblastoma patients. Neuro Oncol 20(10):1374–1382CrossRefPubMedPubMedCentral Brown DA, Himes BT, Kerezoudis P et al (2018) Insurance correlates with improved access to care and outcome among glioblastoma patients. Neuro Oncol 20(10):1374–1382CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Bojko MM, Kucejko RJ, Poggio JL (2018) Racial disparities and the effect of county level income on the incidence and survival of young men with anal cancer. Health Equity 2(1):193–198CrossRefPubMedPubMedCentral Bojko MM, Kucejko RJ, Poggio JL (2018) Racial disparities and the effect of county level income on the incidence and survival of young men with anal cancer. Health Equity 2(1):193–198CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Altman AD, Lambert P, Love AJ et al (2017) Examining the effects of time to diagnosis, income, symptoms, and incidental detection on overall survival in epithelial ovarian cancer: manitoba ovarian cancer outcomes (MOCO) study group. Int J Gynecol Cancer. 27(8):1637–1644CrossRefPubMed Altman AD, Lambert P, Love AJ et al (2017) Examining the effects of time to diagnosis, income, symptoms, and incidental detection on overall survival in epithelial ovarian cancer: manitoba ovarian cancer outcomes (MOCO) study group. Int J Gynecol Cancer. 27(8):1637–1644CrossRefPubMed
26.
Zurück zum Zitat Steenland K, Rodriguez C, Mondul A, Calle EE, Thun M (2004) Prostate cancer incidence and survival in relation to education (United States). Cancer Causes Control 15(9):939–945CrossRefPubMed Steenland K, Rodriguez C, Mondul A, Calle EE, Thun M (2004) Prostate cancer incidence and survival in relation to education (United States). Cancer Causes Control 15(9):939–945CrossRefPubMed
27.
Zurück zum Zitat Smailyte G, Jasilionis D, Vincerzevskiene I, Shkolnikov VM (2016) Education, survival, and avoidable deaths in Lithuanian cancer patients, 2001-2009. Acta Oncol 55(7):859–864CrossRefPubMed Smailyte G, Jasilionis D, Vincerzevskiene I, Shkolnikov VM (2016) Education, survival, and avoidable deaths in Lithuanian cancer patients, 2001-2009. Acta Oncol 55(7):859–864CrossRefPubMed
28.
Zurück zum Zitat de Vries E, Uribe C, Pardo C, Lemmens V, Van de Poel E, Forman D (2015) Gastric cancer survival and affiliation to health insurance in a middle-income setting. Cancer Epidemiol 39(1):91–96CrossRefPubMed de Vries E, Uribe C, Pardo C, Lemmens V, Van de Poel E, Forman D (2015) Gastric cancer survival and affiliation to health insurance in a middle-income setting. Cancer Epidemiol 39(1):91–96CrossRefPubMed
29.
Zurück zum Zitat Hussain SK, Altieri A, Sundquist J, Hemminki K (2008) Influence of education level on breast cancer risk and survival in Sweden between 1990 and 2004. Int J Cancer 122(1):165–169CrossRefPubMed Hussain SK, Altieri A, Sundquist J, Hemminki K (2008) Influence of education level on breast cancer risk and survival in Sweden between 1990 and 2004. Int J Cancer 122(1):165–169CrossRefPubMed
30.
Zurück zum Zitat Hussain SK, Lenner P, Sundquist J, Hemminki K (2008) Influence of education level on cancer survival in Sweden. Ann Oncol 19(1):156–162CrossRefPubMed Hussain SK, Lenner P, Sundquist J, Hemminki K (2008) Influence of education level on cancer survival in Sweden. Ann Oncol 19(1):156–162CrossRefPubMed
31.
Zurück zum Zitat Brusselaers N, Ljung R, Mattsson F et al (2013) Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study. BMJ Open 3(12):e003754CrossRefPubMedPubMedCentral Brusselaers N, Ljung R, Mattsson F et al (2013) Education level and survival after oesophageal cancer surgery: a prospective population-based cohort study. BMJ Open 3(12):e003754CrossRefPubMedPubMedCentral
32.
Zurück zum Zitat Ansell D, Whitman S, Lipton R, Cooper R (1993) Race, income, and survival from breast cancer at two public hospitals. Cancer 72(10):2974–2978CrossRefPubMed Ansell D, Whitman S, Lipton R, Cooper R (1993) Race, income, and survival from breast cancer at two public hospitals. Cancer 72(10):2974–2978CrossRefPubMed
33.
Zurück zum Zitat Vincerzevskiene I, Jasilionis D, Austys D, Stukas R, Kaceniene A, Smailyte G (2017) Education predicts cervical cancer survival: a Lithuanian cohort study. Eur J Public Health 27(3):421–424PubMed Vincerzevskiene I, Jasilionis D, Austys D, Stukas R, Kaceniene A, Smailyte G (2017) Education predicts cervical cancer survival: a Lithuanian cohort study. Eur J Public Health 27(3):421–424PubMed
34.
Zurück zum Zitat Herndon JE 2nd, Kornblith AB, Holland JC, Paskett ED (2008) Patient education level as a predictor of survival in lung cancer clinical trials. J Clin Oncol 26(25):4116–4123CrossRefPubMedPubMedCentral Herndon JE 2nd, Kornblith AB, Holland JC, Paskett ED (2008) Patient education level as a predictor of survival in lung cancer clinical trials. J Clin Oncol 26(25):4116–4123CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Herndon JE 2nd, Kornblith AB, Holland JC, Paskett ED (2013) Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials. Psychooncology 22(2):315–323PubMed Herndon JE 2nd, Kornblith AB, Holland JC, Paskett ED (2013) Effect of socioeconomic status as measured by education level on survival in breast cancer clinical trials. Psychooncology 22(2):315–323PubMed
36.
Zurück zum Zitat Boyd C, Zhang-Salomons JY, Groome PA, Mackillop WJ (1999) Associations between community income and cancer survival in Ontario, Canada, and the United States. J Clin Oncol 17(7):2244–2255CrossRefPubMed Boyd C, Zhang-Salomons JY, Groome PA, Mackillop WJ (1999) Associations between community income and cancer survival in Ontario, Canada, and the United States. J Clin Oncol 17(7):2244–2255CrossRefPubMed
37.
Zurück zum Zitat Dalton SO, Steding-Jessen M, Gislum M, Frederiksen K, Engholm G, Schuz J (2008) Social inequality and incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: background, aims, materials and methods. Eur J Cancer 44(14):1938–1949CrossRefPubMed Dalton SO, Steding-Jessen M, Gislum M, Frederiksen K, Engholm G, Schuz J (2008) Social inequality and incidence of and survival from cancer in a population-based study in Denmark, 1994-2003: background, aims, materials and methods. Eur J Cancer 44(14):1938–1949CrossRefPubMed
38.
Zurück zum Zitat Gorey KM (2009) Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas. Int J Epidemiol 38(6):1543–1551CrossRefPubMedPubMedCentral Gorey KM (2009) Breast cancer survival in Canada and the USA: meta-analytic evidence of a Canadian advantage in low-income areas. Int J Epidemiol 38(6):1543–1551CrossRefPubMedPubMedCentral
39.
Zurück zum Zitat Gorey KM, Fung KY, Luginaah IN, Holowaty EJ, Hamm C (2010) Income and long-term breast cancer survival: comparisons of vulnerable urban places in Ontario and California. Breast J 16(4):416–419PubMedPubMedCentral Gorey KM, Fung KY, Luginaah IN, Holowaty EJ, Hamm C (2010) Income and long-term breast cancer survival: comparisons of vulnerable urban places in Ontario and California. Breast J 16(4):416–419PubMedPubMedCentral
40.
Zurück zum Zitat Gorey KM, Kanjeekal SM, Wright FC et al (2015) Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada. Int J Equity Health 14:109CrossRefPubMedPubMedCentral Gorey KM, Kanjeekal SM, Wright FC et al (2015) Colon cancer care and survival: income and insurance are more predictive in the USA, community primary care physician supply more so in Canada. Int J Equity Health 14:109CrossRefPubMedPubMedCentral
41.
Zurück zum Zitat Bajaj A, Martin B, Bhasin R et al (2018) The impact of academic facility type and case volume on survival in patients undergoing curative radiation therapy for muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys 100(4):851–857CrossRefPubMed Bajaj A, Martin B, Bhasin R et al (2018) The impact of academic facility type and case volume on survival in patients undergoing curative radiation therapy for muscle-invasive bladder cancer. Int J Radiat Oncol Biol Phys 100(4):851–857CrossRefPubMed
42.
Zurück zum Zitat Cheraghlou S, Kuo P, Judson BL (2017) Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope 127(3):616–622CrossRefPubMed Cheraghlou S, Kuo P, Judson BL (2017) Treatment delay and facility case volume are associated with survival in early-stage glottic cancer. Laryngoscope 127(3):616–622CrossRefPubMed
43.
Zurück zum Zitat Baade PD, Dasgupta P, Aitken JF, Turrell G (2011) Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 195(6):350–354CrossRefPubMed Baade PD, Dasgupta P, Aitken JF, Turrell G (2011) Distance to the closest radiotherapy facility and survival after a diagnosis of rectal cancer in Queensland. Med J Aust 195(6):350–354CrossRefPubMed
44.
Zurück zum Zitat Chen YW, Mahal BA, Muralidhar V et al (2016) Association between treatment at a high-volume facility and improved survival for radiation-treated men with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 94(4):683–690CrossRefPubMed Chen YW, Mahal BA, Muralidhar V et al (2016) Association between treatment at a high-volume facility and improved survival for radiation-treated men with high-risk prostate cancer. Int J Radiat Oncol Biol Phys 94(4):683–690CrossRefPubMed
45.
Zurück zum Zitat Koshy M, Malik R, Mahmood U, Husain Z, Sher DJ (2015) Stereotactic body radiotherapy and treatment at a high volume facility is associated with improved survival in patients with inoperable stage I non-small cell lung cancer. Radiother Oncol 114(2):148–154CrossRefPubMed Koshy M, Malik R, Mahmood U, Husain Z, Sher DJ (2015) Stereotactic body radiotherapy and treatment at a high volume facility is associated with improved survival in patients with inoperable stage I non-small cell lung cancer. Radiother Oncol 114(2):148–154CrossRefPubMed
46.
Zurück zum Zitat Boffa DJ, Rosen JE, Mallin K et al (2017) Using the national cancer database for outcomes research: a review. JAMA Oncol 3(12):1722–1728CrossRefPubMed Boffa DJ, Rosen JE, Mallin K et al (2017) Using the national cancer database for outcomes research: a review. JAMA Oncol 3(12):1722–1728CrossRefPubMed
Metadaten
Titel
Racial/ethnic differences in survival for patients with gliosarcoma: an analysis of the National cancer database
verfasst von
James M. Wright
Tiffany R. Hodges
Christina Huang Wright
Haley Gittleman
Xiaofei Zhou
Kelsey Duncan
Carol Kruchko
Andrew Sloan
Jill S. Barnholtz-Sloan
Publikationsdatum
13.04.2019
Verlag
Springer US
Erschienen in
Journal of Neuro-Oncology / Ausgabe 2/2019
Print ISSN: 0167-594X
Elektronische ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-019-03170-7

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