Rhome Ryan, Fisher Rebecca, Hormigo Adília, Parikh Rahul R
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Division of Neuro-Oncology, Department of Neurology, Icahn School of Medicine at Mount Sinai, 1470 Madison Avenue, 3rd Floor, New York, NY, 10029, USA.
J Neurooncol. 2016 Jun;128(2):241-50. doi: 10.1007/s11060-016-2101-5. Epub 2016 Mar 12.
Temozolomide given concurrently with radiation after resection/biopsy improves survival in glioblastoma (GBM). The disparities in receipt of adjuvant single-agent chemotherapy and their association with outcome have not been well established. Observational study of a prospectively collected database, the National Cancer Database (NCDB), from 1998 to 2012 with median follow-up 12.4 months. Among the 114,979 patients in the NCDB with GBM, 44,531 patients were analyzed for disparities, and 28,279 patients were analyzed for overall survival (OS). Associations were assessed in a multivariable Cox proportional hazards regression model. Survival was estimated using the Kaplan-Meier method. Median age was 58 years. Chemotherapy use was associated with male gender, white race, younger age (≤50), higher performance status (≥70), more extensive surgery, insurance status, higher income/education, and treatment at academic centers (all p < 0.05). We found improved OS associated with type of insurance (private insurance HR 0.91, 95 % CI 0.85-0.96 and Medicare HR 1.24, 95 % CI 1.16-1.33, both p < 0.01 compared to uninsured) and treatment at academic programs (HR 0.86; p < 0.01). MGMT methylation status predicted improved OS (HR 0.54; 95 % CI 0.41-0.70, p < 0.01). 1-year OS for patients receiving chemotherapy was 55.9 % versus 35.3 % for those without (p < 0.0001). After adjustment for confounders, chemotherapy use remained associated with improved OS (HR 0.64, 95 % CI 0.63-0.66, p < 0.01). Chemotherapy utilization increased from 26.9 to 93.3 % during the study period. We have identified specific disparities in the use of chemotherapy that may be targeted to improve patient access to care. Widespread adoption of adjuvant chemoradiotherapy after resection or biopsy for GBM appears to improve OS.
胶质母细胞瘤（GBM）切除/活检后同步给予替莫唑胺与放疗可提高生存率。辅助单药化疗的接受情况差异及其与预后的关联尚未明确确立。对1998年至2012年前瞻性收集的数据库——国家癌症数据库（NCDB）进行观察性研究，中位随访时间为12.4个月。在NCDB中114,979例GBM患者中，44,531例患者被分析差异情况，28,279例患者被分析总生存期（OS）。在多变量Cox比例风险回归模型中评估关联。使用Kaplan-Meier方法估计生存率。中位年龄为58岁。化疗的使用与男性、白人种族、较年轻年龄（≤50岁）、较高的体能状态（≥70）、更广泛的手术、保险状况、更高的收入/教育水平以及在学术中心接受治疗相关（所有p<0.05）。我们发现总生存期的改善与保险类型（私人保险HR 0.91，95%CI 0.85 - 0.96；医疗保险HR 1.24，95%CI 1.16 - 1.33，与未参保相比均p<0.01）以及在学术项目中接受治疗（HR 0.86；p<0.01）相关。O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）甲基化状态预示总生存期改善（HR 0.54；95%CI 0.41 - 0.70，p<0.01）。接受化疗患者的1年总生存率为55.9%，未接受化疗患者为35.3%（p<0.0001）。在对混杂因素进行调整后，化疗的使用仍然与总生存期改善相关（HR 0.64，95%CI 0.63 - 0.66，p<0.01）。在研究期间，化疗的使用率从26.9%增加到93.3%。我们已经确定了化疗使用方面的特定差异，这些差异可能是改善患者获得医疗服务的目标。GBM切除或活检后广泛采用辅助放化疗似乎可改善总生存期。
