Sarfraz Zouina, Jayram Diya, Ozair Ahmad, Hodgson Lydia, Bellur Shreyas, Maharaj Arun, Mansouri Alireza, Ahluwalia Manmeet S
Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA.
Department of Neurosurgery, University of Maryland, Baltimore, MD 20742, USA.
Brain Sci. 2025 May 23;15(6):556. doi: 10.3390/brainsci15060556.
Despite advances in glioblastoma (GBM) management, median overall survival (mOS) remains poor, and multi-modal disparities persist. We sought to evaluate trends in GBM treatment and survival outcomes from 2005-2020, with a focus on sociodemographic and geographic disparities. We conducted a retrospective US-based cohort study using the National Cancer Database (NCDB), stratifying study period into four intervals (2005-2008, 2009-2012, 2013-2016, and 2017-2020). Logistic regression was used to identified predictors of receipt of combination surgery, radiation, and chemotherapy (Sx+RT+Chemo). Kaplan-Meier and multivariable Cox proportional hazards approaches were used to assess mOS. A total of 111,955 adults with GBM were included. From 2005-2008 to 2017-2020, mOS increased from 7.8 to 9.5 months, with geographically unequal gains in survival across the US. In multivariable logistic regression model adjusting for known confounders, combined Sx+RT+Chemo was less likely to be received by female patients (OR 0.90, 95% CI 0.88-0.92) vs. male, non-White patients (OR 0.90, 95% CI 0.86-0.94) vs. White, patients treated at community hospitals (OR: 0.78, 95% CI 0.76-0.80) vs. academic centers, publicly-insured patients (OR 0.74, 95% CI 0.71-0.76) or uninsured patients (OR 0.54, 95% CI 0.50-0.58) vs. privately-insured, and patients living in the South (OR 0.88, 95% CI 0.85-0.91), Midwest (OR 0.83, 95% CI 0.80-0.86), and West (OR 0.85, 95% CI 0.81-0.88) compared to the Northeast. In multivariable Cox regression, significantly poorer survival was seen amongst non-metropolitan patients, community-based hospital patients, and publicly-insured and uninsured patients (vs. privately-insured), despite adjusting for prognostic factors. Only modest improvement in mOS of GBM patients has occurred across 2005-2020, with persistent disparities linked to sociodemographic and structural factors, whose redressal warrants multi-pronged efforts.
尽管胶质母细胞瘤（GBM）的治疗取得了进展，但总体中位生存期（mOS）仍然很差，多模式治疗的差异依然存在。我们试图评估2005年至2020年GBM治疗和生存结果的趋势，重点关注社会人口统计学和地理差异。我们使用美国国家癌症数据库（NCDB）进行了一项基于美国的回顾性队列研究，将研究期分为四个时间段（2005 - 2008年、2009 - 2012年、2013 - 2016年和2017 - 2020年）。采用逻辑回归来确定接受联合手术、放疗和化疗（Sx + RT + 化疗）的预测因素。使用Kaplan - Meier法和多变量Cox比例风险方法来评估mOS。总共纳入了111,955名患有GBM的成年人。从2005 - 2008年到2017 - 2020年，mOS从7.8个月增加到9.5个月，美国各地的生存改善在地理上并不均衡。在调整已知混杂因素的多变量逻辑回归模型中，女性患者（OR 0.90，95% CI 0.88 - 0.92）与男性相比、非白人患者（OR 0.90，95% CI 0.86 - 0.94）与白人相比、在社区医院接受治疗的患者（OR：0.78，95% CI 0.76 - 0.80）与学术中心相比、公共保险患者（OR 0.74，95% CI 0.71 - 0.76）或未参保患者（OR 0.54，95% CI 0.50 - 0.58）与私人保险患者相比，以及居住在南部（OR 0.88，95% CI 0.85 - 0.91）、中西部（OR 0.83，95% CI 0.80 - 0.86）和西部（OR 0.85，95% CI 0.81 - 0.88）的患者与东北部相比，接受联合Sx + RT + 化疗的可能性较小。在多变量Cox回归中，尽管对预后因素进行了调整，但在非大都市患者、社区医院患者以及公共保险和未参保患者（与私人保险患者相比）中观察到生存情况明显较差。在2005年至2020年期间，GBM患者的mOS仅出现了适度改善，与社会人口统计学和结构因素相关的差异仍然存在，纠正这些差异需要多方面的努力。
