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).

Primary Central Nervous System lymphoma (PCNSL) is a rare and aggressive malignancy with variable survival outcomes. This study aimed to evaluate the impact of racial and socioeconomic disparities on survival outcomes in PCNSL and to identify independent prognostic factors using a large US population-based database. This retrospective cohort study analyzed data from the SEER-17 database for patients diagnosed with PCNSL between 2000 and 2021. Demographic, socioeconomic, and treatment variables were extracted. Kaplan-Meier analysis assessed overall survival (OS) and cancer-specific survival (CSS) across subgroups, and multivariable Cox proportional hazards models identified independent prognostic factors. A total of 7,068 patients were included (52.3% male; mean age 63 ± 15 years). Racial composition was 63.9% Caucasian, 16.0% Hispanic, 12.2% Asian/Pacific Islander, 7.3% African American, and 0.4% American Indian/Alaskan Native. Median OS differed significantly by race (p < 0.001), ranging from 5 months in American Indian/Alaskan Natives to 22 months in Asian/Pacific Islanders. Higher income (≥ $75,000) was associated with improved median OS compared to < $50,000 (13 vs. 6 months; p < 0.001). Patients diagnosed after 2019 had markedly better outcomes (mOS 19 vs. 11 months; p = 0.001), with CSS not reached post-2019. Significant racial and socioeconomic disparities in PCNSL survival were identified. Higher income, chemotherapy, and radiation were independently associated with improved survival, while older age and male sex predicted worse outcomes. The improvement in outcomes after 2019 likely reflects recent advances in PCNSL management, highlighting the need for equitable access to emerging therapies.