Racial and socioeconomic disparities in long-term survival in craniopharyngioma: a SEER database analysis

The aim of this study was to characterize sociodemographic disparities in long-term survival outcomes among adults and children with craniopharyngioma and evaluate their impact on surgical approach and radiation therapy (RT).

Using the Surveillance, Epidemiology, and End Results database (2000-2022), the authors retrospectively identified adult (age ≥ 18 years) and pediatric patients with craniopharyngioma who had undergone resection. Log-rank tests and multivariable Cox proportional hazards regression were used to assess the impact of race/ethnicity, county-level median household income, extent of resection, and RT on overall survival. Separate analyses were performed for pediatric and adult cohorts.

The cohort consisted of 3132 patients with craniopharyngioma, including 832 pediatric and 2300 adult patients. Racial disparities were identified, with non-Hispanic Black patients demonstrating 15-year survival of 39.8% in adults and 75.7% in children compared with 52.5% and 88.6% for White patients, respectively. After multivariable adjustment, Black race remained an adverse prognostic factor in both pediatric (HR 2.9, 95% CI 1.56-5.56, p < 0.001) and adult (HR 1.67, 95% CI 1.39-2.15, p < 0.001) cohorts. Among adults, both Hispanic (HR 0.78, 95% CI 0.62-0.98, p = 0.003) and Asian/Pacific Islander (HR 0.654, 95% CI 0.472-0.905, p = 0.01) races were independently protective compared with White race. There were significant income-based disparities (p = 0.0029) concentrated among adults undergoing subtotal resection (STR), where lower-income patients demonstrated 15-year survival of 42.1% compared with 63.5% for higher-income patients; outcomes after gross-total resection (GTR) were comparable based on income strata (57.3% vs 57.7%, respectively). Among adults, STR with RT led to a 15-year survival of 63.7%-not significantly different from GTR with RT (58.2%)-whereas STR alone showed inferior outcomes (49.7%). Among pediatric patients, extent of resection did not independently predict survival, whereas RT was protective (HR 0.55, 95% CI 0.301-0.994, p = 0.048).

Substantial racial and socioeconomic disparities in survival persist in craniopharyngioma, even after adjusting for tumor characteristics and treatment received. Non-Hispanic Black patients in both age groups experienced inferior outcomes. Income-based disparities were concentrated among adults who had undergone conservative surgical approaches, suggesting differential access to adjuvant RT. Selection bias limited direct treatment comparisons; however, conservative resection without adjuvant RT was associated with significantly inferior outcomes. Ensuring equitable access to multimodal treatment and addressing structural barriers to specialized care may help reduce these disparities.