Racial and socioeconomic disparities in long-term survival in craniopharyngioma: a SEER database analysis.
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OBJECTIVE: 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). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.