Unraveling survival disparities in primary central nervous system (CNS) lymphoma: An analysis of race, socioeconomic factors, and treatment outcomes using the Surveillance, Epidemiology, and End Results program (2000–2021).

Abstract

2086 Background: Primary central nervous system lymphoma (PCNSL) is a rare B-cell non-Hodgkin lymphoma with survival outcomes influenced by treatment, demographic, and socioeconomic factors (Villano JL et al., Br J Cancer, 2011). This study evaluated survival disparities associated with race, socioeconomic status (SES), and treatment modalities in PCNSL patients using a large U.S. population database. Methods: This retrospective cohort study used the SEER-17 database to analyze data from 7,068 patients diagnosed with PCNSL between 2000 and 2021. Demographic, socioeconomic, and treatment data were collected. Kaplan-Meier analysis was used to compare survival across groups, and Cox proportional hazards models identified independent prognostic factors. Results: The cohort included 7,068 patients (52.3% male; mean age: 63 years, SD ± 15). Racial distribution was 63.9% Caucasians, 16.0% Hispanics, 12.2% Asian/Pacific Islanders, 7.3% African Americans, and 0.4% American Indian/Alaskan Natives. Among these, 27.3% received radiation, and 64.3% received chemotherapy. During the study period, 73.5% of patients died from PCNSL. Survival analysis revealed that Asian/Pacific Islanders had the longest median overall survival (OS) at 22 months (95% CI: 16.5–27.5), followed by Hispanics (16 months; 95% CI: 11.8–20.2), Caucasians (11 months; 95% CI: 9.8–12.2), and American Indian/Alaskan Natives with the shortest survival at 5 months (95% CI: 0–11.2) (p<0.001). Socioeconomic analysis showed a direct association between higher income and improved OS: patients with household incomes ≥75k had a median OS of 13 months (95% CI: 11.2–14.8), compared to 6 months (95% CI: 4.2–7.8) in those earning <50k (p<0.001). Multivariable Cox regression identified male sex (HR 1.21, p<0.001) and older age (HR 1.027, p<0.001) as adverse prognostic factors, while chemotherapy significantly improved survival (HR 0.43, p<0.001). Radiation provided a modest benefit (HR 0.913, p=0.005). Conclusions: This large study demonstrates that lower income levels and racial disparities are associated with reduced survival in PCNSL. Findings underscore the need for equitable healthcare access and tailored therapeutic strategies to address these inequities. Keywords: CNS lymphoma, survival disparities, socioeconomic status, race, treatment outcomes, public health oncology.