Sun Yifei, Estevez-Ordonez Dagoberto, Atchley Travis J, Nabors Burt, M Markert James
Marnix E. Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA.
J Neurooncol. 2025 Jun;173(2):457-467. doi: 10.1007/s11060-025-05002-3. Epub 2025 Apr 7.
Glioblastoma is the most common primary brain malignancy. Though literature has suggested the association of glioblastoma outcomes and socioeconomic status, there is limited evidence regarding the association of neighborhood-level socioeconomic deprivation on glioblastoma outcomes. The aim of this study was to assess the impact of neighborhood-level socioeconomic deprivation on glioblastoma survival. We retrospectively reviewed all adult glioblastoma patients seen at a single institution from 2008 to 2023. Neighborhood deprivation was assessed via Area Deprivation Index (ADI), with higher ADI indicating greater neighborhood socioeconomic disadvantage. Log-rank tests and multivariate cox regression was used to assess the effect of ADI and other socioeconomic variables while controlling for a priori selected clinical variables with known relevance to survival. In total, 1464 patients met inclusion criteria. The average age at diagnosis was 60 ± 14 years with a median overall survival of 13.8 months (IQR 13-14.8). The median ADI of the cohort was 66(IQR 46-84). Patients with high neighborhood disadvantage had worse overall survival compared to patients with those without (11.7 vs. 14.8 months, p =.001). In the multivariable model, patients with high neighborhood disadvantage had worse overall survival (HR 1.25, 95%CI 1.09-1.43). To account for changes in WHO guidelines, we implemented the model on patients diagnosed between 2017 and 2023 and findings were consistent (HR 1.26,95%CI 1.01-1.56). We report the first study demonstrating glioblastoma patients with higher neighborhood deprivation have worse survival after controlling for other socioeconomic and biomolecular markers. Neighborhood socioeconomic status may be a prognostic marker for glioblastoma survival.
胶质母细胞瘤是最常见的原发性脑恶性肿瘤。尽管文献表明胶质母细胞瘤的预后与社会经济地位有关，但关于社区层面社会经济剥夺与胶质母细胞瘤预后之间的关联证据有限。本研究的目的是评估社区层面社会经济剥夺对胶质母细胞瘤生存的影响。我们回顾性分析了2008年至2023年在一家机构就诊的所有成年胶质母细胞瘤患者。通过区域剥夺指数（ADI）评估社区剥夺情况，ADI越高表明社区社会经济劣势越大。采用对数秩检验和多变量Cox回归评估ADI和其他社会经济变量的影响，同时控制预先选定的与生存相关的临床变量。共有1464例患者符合纳入标准。诊断时的平均年龄为60±14岁，中位总生存期为13.8个月（四分位间距13 - 14.8）。队列的中位ADI为66（四分位间距46 - 84）。与无社区劣势的患者相比，社区劣势高的患者总生存期更差（11.7个月对14.8个月，p = 0.001）。在多变量模型中，社区劣势高的患者总生存期更差（风险比1.25，95%置信区间1.09 - 1.43）。为了考虑世界卫生组织指南的变化，我们在2017年至2023年诊断的患者中应用该模型，结果一致（风险比1.26，95%置信区间1.01 - 1.56）。我们报告了第一项研究，表明在控制其他社会经济和生物分子标志物后，社区剥夺程度较高的胶质母细胞瘤患者生存更差。社区社会经济地位可能是胶质母细胞瘤生存的一个预后标志物。
