Department of Neurological Surgery, University of Miami, Miami, FL, USA.
Department of Neurological Surgery, Nicklaus Children's Hospital, Miami, FL, USA.
J Neurooncol. 2022 Oct;160(1):171-178. doi: 10.1007/s11060-022-04130-4. Epub 2022 Sep 8.
The diagnosis of malignant glioma confers a poor prognosis in the pediatric population. In the adult demographic, racial disparities exist with respect to access to care and survival. Yet to date no efforts have been made to characterize racial disparities in the care of malignant pediatric gliomas. Correspondingly, the aim of this study was to understand if racial disparities exist in the setting of malignant pediatric gliomas.
All pediatric malignant gliomas patients with known race status (White, Black, Other) in the US National Cancer Database (NCDB) between the years 2005-2016 were retrospectively reviewed. Demographic, socioeconomic and clinical data were then abstracted and analyzed by comparison and regression techniques.
A total of 1803 pediatric malignant glioma cases were identified, with 48% female and a median age of 8 years old. Brainstem locations were reported in 48% of cases. Socioeconomically, there were statistically significant differences with respect to insurance status, yearly income, household education level and metropolitan residences between the racial groups (all P < 0.01). With respect to treatment, there was statistical difference in the proportion of patients treated with surgical resection (White 43% vs Black 34% vs Other 37%, P = 0.02). There were no differences between race groups for radiation therapy (P = 0.73) or chemotherapy (P = 0.12). The odds of surgical resection were significantly less in the Black group compared to the White group (OR 0.69, P < 0.01), although there was no difference in overall survival between the two groups in those treated with (P = 0.44) or without (P = 0.27) surgical resection. Primary associations of surgical resection in the Black group were brainstem location (P < 0.05) and lower yearly household income quartiles (P < 0.05).
Racial disparities exist amongst the management of pediatric malignant gliomas, with undefined impact on survival and quality of life. In this perspective, we identified associations between Black patients and access to surgical treatment. Understanding that there are many elements to patient care, including quality of life, should encourage all clinicians and carers to consider racial disparities appropriately when managing malignant pediatric glioma patients.
恶性脑胶质瘤的诊断在儿科人群中预后较差。在成人人群中，在获得治疗和生存方面存在种族差异。但迄今为止，尚未有人努力描述恶性小儿脑胶质瘤治疗中的种族差异。相应地，本研究的目的是了解恶性小儿脑胶质瘤是否存在种族差异。
在美国国家癌症数据库（NCDB）中回顾性分析了 2005 年至 2016 年间已知种族（白种人、黑种人、其他）的所有小儿恶性脑胶质瘤患者。然后通过比较和回归技术提取和分析人口统计学、社会经济学和临床数据。
共确定了 1803 例小儿恶性脑胶质瘤病例，其中 48%为女性，中位年龄为 8 岁。报告了 48%的病例位于脑干。在社会经济学方面，种族之间在保险状况、年收入、家庭教育水平和大都市居住方面存在统计学上显著差异（均 P<0.01）。在治疗方面，手术切除的患者比例存在统计学差异（白种人 43%，黑种人 34%，其他种族 37%，P=0.02）。种族之间的放射治疗（P=0.73）或化疗（P=0.12）无差异。与白种人相比，黑种人的手术切除几率明显较低（OR 0.69，P<0.01），尽管在接受（P=0.44）或不接受（P=0.27）手术切除的两组之间，总体生存率无差异。在黑种人中，手术切除的主要关联是脑干位置（P<0.05）和较低的年收入四分位数（P<0.05）。
小儿恶性脑胶质瘤的管理中存在种族差异，对生存和生活质量的影响尚未确定。在这种情况下，我们确定了黑种人与手术治疗机会之间的关联。了解到患者护理有许多要素，包括生活质量，应鼓励所有临床医生和护理人员在管理恶性小儿脑胶质瘤患者时适当考虑种族差异。
