COMMENTARY

Non-Hispanic White Patients Have Higher Glioma Incidence, Lower Survival

Laurie L. Barclay, MD

Disclosures

August 23, 2018

Adult Glioma Incidence and Survival by Race or Ethnicity in the United States From 2000 to 2014

Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS
JAMA Oncol. 2018 Jun 21:e181789. [Epub ahead of print]

Summary

In the United States, glioma is the most commonly occurring malignant brain tumor, causing significant morbidity and mortality.[1] For glioblastoma, the most prevalent type of glioma, the 5-year survival rate is approximately only 5%.[1] Age, sex, and race or ethnicity affect glioma incidence,[1] and race and ethnicity have also been linked to survival after glioma diagnosis.[2,3] The goal of this population-based analysis was to quantify differences in incidence and survival rates of glioma in adults on the basis of race or ethnicity.

Incidence data from January 1, 2000, to December 31, 2014, were collected from the Central Brain Tumor Registry of the United States, and survival data for the same period were obtained from the Surveillance, Epidemiology, and End Results Program (SEER) registries. The investigators determined average annual age-adjusted glioma incidence rates stratified by histology, race, Hispanic ethnicity, sex, and age. One-year and 5-year relative survival rates were stratified by histology, race, Hispanic ethnicity, and insurance status.

Of 244,808 adults (56.3% male) aged ≥ 18 years with glioma, 150,631 (61.5%) had glioblastoma, 46,002 (18.8%) had nonglioblastoma astrocytoma, 26,068 (10.7%) had oligodendroglial tumors, 8816 (3.6%) had ependymoma, and 13,291 (5.4%) had other gliomas. The study population included non-Hispanic white (83.6%), Hispanic white (7.08%), black (6.0%), Asian or Pacific Islander (2.4%), and American Indian or Alaska Native (0.4%).

Non-Hispanic whites had higher incidence rates of glioblastoma, nonglioblastoma astrocytoma, and oligodendroglial tumors than did American Indians or Alaska Natives (58% lower overall), blacks (52% lower overall), Asians or Pacific Islanders (52% lower overall), or Hispanic whites (30% lower overall). For all histologic subtypes of glioma, non-Hispanic whites also had the oldest median age at diagnosis.

Across all races and ethnicities analyzed, men were more likely than women to have gliomas, particularly glioblastoma, for which incidence was 60% higher in males. More than three quarters of gliomas (79.9%) occurred in persons aged ? 45 years, and all age groups had differences in incidence when stratified by race or ethnicity.

Hispanic white, black, or Asian or Pacific Islander patients had generally comparable survival rates after diagnosis of different subtypes of glioma. However, non-Hispanic white patients had lower survival for glioblastoma and many other glioma subtypes, regardless of treatment regimen.

Viewpoint

Study limitations include possible ascertainment bias, low proportions of racial and ethnic groups other than non-Hispanic whites, and lack of data on molecular subtypes of glioma. Nonetheless, this large population-based analysis represents the most complete and up-to-date reporting of glioma incidence and survival by race or ethnicity in the United States, with incidence estimates including approximately 99.9% of the US population.[1] The findings indicate that non-Hispanic whites had the highest incidence and lowest relative survival rates for most histologic subtypes of glioma. Differences in incidence and survival based on race or ethnicity can inform future identification of risk factors and detect unaddressed health disparities.

For cancer at other sites, survival has been linked to many characteristics that also vary by race or ethnicity, such as body mass index, smoking, and religious service attendance. Such associations should also be explored for gliomas, as data used in the present analysis were limited in the variables available for each individual. Research studying germline genetic associations in black and Hispanic white persons may help identify genetic components of differences in incidence, and molecular characterization is also needed. Future studies should also assess treatment patterns in databases that include more extensive clinical information to evaluate the contribution of healthcare access to differences in outcomes.

Abstract

 

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