Racial disparities in the survival outcomes of craniopharyngioma: a 17-year population-based analysis.
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OBJECTIVE: Craniopharyngioma is a rare epithelial tumor of the sellar and suprasellar regions that, despite benign histology, causes substantial morbidity due to proximity to critical structures. Racial disparities have been recognized in other CNS tumors, but the impact on craniopharyngioma outcomes remains poorly defined. This study evaluated racial differences in survival and treatment patterns in a contemporary, population-based cohort. METHODS: Patients with craniopharyngioma from 2004 to 2020 were identified from the SEER (Surveillance, Epidemiology, and End Results) 17 registries. Race was categorized as White, Black, or other. Hispanic ethnicity was analyzed separately. Overall survival (OS) was assessed using Kaplan-Meier estimates and restricted mean survival time (RMST) at 5 and 10 years. Sequential Cox models assessed the contribution of demographics, tumor, and treatment variables. Adjusted probabilities of gross-total resection (GTR) and radiation therapy (RT) were estimated using regression with marginal standardization. RESULTS: A total of 2651 patients met inclusion criteria (White, n = 1891; Black, n = 441; other, n = 319). Black patients more often resided in lower-income and urban areas. OS differed significantly by race (log-rank, p < 0.0001): the 5-year OS was 78.4% for Black, 85.2% for White, and 82.1% for other-race patients. RMST analysis demonstrated a survival deficit for Black versus White patients (-5.6 months at 5 years, -17.9 months at 10 years). In multivariable models, including adjustment for county-level median household income, Black race remained independently associated with worse OS (HR 2.28, 95% CI 1.87-2.78; p < 0.001), while other race was protective (HR 0.71, 95% CI 0.51-0.99; p = 0.05). Adjusted probabilities of GTR and RT did not differ significantly across races. CONCLUSIONS: Black patients with craniopharyngioma had significantly worse long-term survival despite comparable rates of surgery and RT. These disparities were not explained by treatment patterns, suggesting that unmeasured variables such as differences in posttreatment care, social determinants of health, or systemic inequities may underlie outcome gaps. Further investigation into survivorship access and longitudinal care pathways is warranted to advance equity in neuro-oncology outcomes.