Differences in factors influencing survival in adult and childhood CNS malignancies

Socioeconomic factors such as income and community type have been shown to correlate with outcomes in adult neuro-oncological care. In pediatric populations, fewer conclusions have been drawn on the effects of factors such as race, sex, and insurance status on survival due to the relative rarity of such cases. This analysis used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program database to evaluate differences in outcomes for factors influencing survival in both pediatric and adult CNS malignancies.

From the SEER research November 2020 (1975-2018) dataset, 29,865 patients with malignant CNS tumors (identified by International Classification of Diseases for Oncology, 3rd ed., code) diagnosed between 1990 and 2018 and directly causing patient deaths were selected. Data were collected on age at diagnosis, sex, race, median household income (in 2019 US dollars), community type (rural-urban continuum), and survival (in months). This cohort was separated into pediatric (ages 0-19 years, n = 1509) and adult (ages ≥ 20 years, n = 28,356) subgroups, and independent survival analysis was conducted by income, community type, sex, and race. Kaplan-Meier curves were visualized for each comparison.

Log-rank analysis of survival in the pediatric cohort showed greater mortality rates in females (p = 0.0224). The same analysis in the adult cohort showed greater mortality rates in lower income groups, more rural community settings, females, and patients categorized as White (p < 0.0001 for all comparisons).

Unlike in the adult population, income, community setting, and race were not associated with significant differences in survival in the pediatric population, prompting further investigation into healthcare delivery differences between pediatric and adult populations. Further study should focus on the cause of these discrepancies to improve equity in neurosurgical care.