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Primary central nervous system tumor treatment and survival in the United States, 2004–2015

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Abstract

Introduction

Brain tumor treatment and survival information is generally limited in large-scale cancer datasets. We provide a clinical investigation of current patterns of care and survival estimates for central nervous system (CNS) tumors treated in the United States.

Methods

We analyzed the National Cancer Database from 2004–2015 for all patients with diagnosis of primary CNS tumors. We describe patient demographics, treatment modality, and analyzed survival estimates.

Results

512,168 patient tumor records were examined. The most common histology was meningioma (43.6%), followed by glioblastoma (22.0%), and nerve sheath tumors (10.6%). Patients had a median age of 60 years, with a female (57.9%), white (85.0%), and non-Hispanic (87.8%) predominance. Tumors were reported as World Health Organization (WHO) grade I for 55.9% of the patients, grade II for 5.9%, grade III for 4.4%, grade IV for 24.3%, and grade unknown or not applicable for 9.4%. Overall, 56% underwent surgical procedures, 30.4% received radiation, and 20.6% received chemotherapy. Radiation plus chemotherapy and surgery was the most common treatment modality in high-grade tumors (40.5% in WHO grade III and 49.3% in WHO grade IV), while surgery only or watchful waiting was preferred in low-grade tumors. Older age, male gender, non-Hispanic origin, higher number of comorbidities, and lower socioeconomic status were identified as risk factors for mortality.

Conclusions

Our analysis provides long-term survival estimates and initial treatment decisions for patients with CNS tumors in hospitals throughout the United States. Age, comorbidities, gender, ethnicity, and socioeconomic characteristics were determinants of survival.

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Funding

Supported by the Biostatistics and Bioinformatics Shared Resource of the University of Kentucky Markey Cancer Center (P30CA177558).

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Authors and Affiliations

  1. Markey Cancer Center, University of Kentucky, Lexington, KY, USA

    Catherine R. Garcia & John L. Villano

  2. Division of Epidemiology and Biostatistics and Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA

    Therese A. Dolecek

  3. Division on Cancer Biostatistics, College of Public Health, University of Kentucky, Lexington, KY, USA

    Bin Huang

  4. Division of Neuropathology, Department of Pathology, University of Kentucky, Lexington, KY, USA

    Janna H. Neltner

  5. Departments of Medicine, Neurology, and Neurosurgery, University of Kentucky, Lexington, KY, USA

    John L. Villano

  6. Department of Statistics, University of Kentucky, Lexington, KY, USA

    Stacey A. Slone

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Correspondence to John L. Villano.

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Garcia, C.R., Slone, S.A., Dolecek, T.A. et al. Primary central nervous system tumor treatment and survival in the United States, 2004–2015. J Neurooncol 144, 179–191 (2019). https://doi.org/10.1007/s11060-019-03218-8

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