Young adult males have worse survival than females that is largely independent of treatment received for many types of central nervous system tumors: A National Cancer Database analysis

• Published in: Cancer 2022-04, Vol.128 (8), p.1616-1625
• Main Authors: Moore, Kristin J., Moertel, Christopher L., Williams, Lindsay A.
• Format: Article
• Language: English
• Subjects: Adults; Astrocytoma; Brain cancer; Brain tumors; Cancer; Central nervous system; Confidence intervals; Death; Diagnosis; Females; Gender aspects; Glioblastoma; Histology; Males; mediation analysis; Meningioma; Mortality; Nervous system; Oncology; public health; Risk analysis; Risk factors; Sex differences; Statistical analysis; Survival; survival disparities; Tumors; young adult brain tumors; Young adults
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.34120

Background Central nervous system (CNS) tumors rank among the top 5 cancers diagnosed in young adults aged 20 to 39 years at diagnosis and show a clear male excess in incidence. It is unknown whether sex differences in survival persist across histologic types and depend on the treatment received. Methods From the National Cancer Database (2004‐2016), young adults (aged 20‐39 years) who had been diagnosed with CNS tumors were identified. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated as measures of association between sex and death via Cox regression. An inverse odds weighting mediation analysis was performed with treatment received as a mediator. Results There were 47,560 cases (47% male). Males had worse overall survival than females for 9 of 16 histologic types, including diffuse astrocytoma, glioblastoma, and meningioma (all P < .05). Males had an increased risk of death after a brain tumor diagnosis overall (HR, 1.47; 95% CI, 1.41‐1.53) and for 8 histologies. There was a significant association between male sex and death overall that was mediated by treatment received (indirect‐effect HR, 1.17; 95% CI, 1.15‐1.18), but no single histology had a significant indirect effect. All histologies examined in mediation analyses had significant direct effects for sex. The excess mortality due to sex was 20% for all CNS tumors combined and 34% among males with CNS tumors. Conclusions Overall, treatment received may mediate a portion of the association between sex and death after a CNS tumor, but sex itself appears to be a stronger risk factor for death in this study. Overall, treatment received may mediate a portion of the association between sex and death after a central nervous system tumor, but sex itself appears to be a stronger risk factor for death in this study. If male survival were equal to that of females, 20% of total deaths and 34% of male deaths would have been avoided.