Authors: Ryan Rhome Rebecca Fisher Adília Hormigo Rahul R Parikh
Publish Date: 2016/03/12
Volume: 128, Issue: 2, Pages: 241-250
Abstract
Temozolomide given concurrently with radiation after resection/biopsy improves survival in glioblastoma GBM The disparities in receipt of adjuvant singleagent 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 followup 124 months Among the 114979 patients in the NCDB with GBM 44531 patients were analyzed for disparities and 28279 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 005 We found improved OS associated with type of insurance private insurance HR 091 95 CI 085–096 and Medicare HR 124 95 CI 116–133 both p 001 compared to uninsured and treatment at academic programs HR 086 p 001 MGMT methylation status predicted improved OS HR 054 95 CI 041–070 p 001 1year OS for patients receiving chemotherapy was 559 versus 353 for those without p 00001 After adjustment for confounders chemotherapy use remained associated with improved OS HR 064 95 CI 063–066 p 001 Chemotherapy utilization increased from 269 to 933 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 OSThe data used in the study are derived from a deidentified NCDB file The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed or the conclusions drawn from these data by the investigator The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society
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