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A population-based multistate model for diffuse large B-cell lymphoma-specific mortality in older patients
Çağlar Çağlayan1, Jordan S Goldstein2, Turgay Ayer1
1H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia.
Cancer
|February 2, 2019
Summary
Outcomes for older adults with diffuse large B-cell lymphoma (DLBCL) vary. Advanced age, stage, comorbidities, and marital status impact survival, while female sex and higher socioeconomic status are protective factors.
Area of Science:
- Oncology
- Geriatric Medicine
- Biostatistics
Background:
- Outcomes for diffuse large B-cell lymphoma (DLBCL) in older adults are inconsistent despite effective treatments.
- Comorbidities and disease biology contribute to heterogeneous survival rates in this population.
Purpose of the Study:
- To analyze survival outcomes and prognostic factors for older patients diagnosed with DLBCL.
- To evaluate the impact of age, comorbidities, and treatment on mortality in DLBCL patients aged 65 and above.
Main Methods:
- A multistate survival analysis was performed on 11,780 DLBCL patients aged ≥65 years using the SEER-Medicare database (2002-2009).
- Cox proportional hazards models and Aalen-Johansen estimator were employed to assess prognostic factors and survival trajectories with or without R-CHOP therapy.
Main Results:
- Advanced age, higher DLBCL stage, Charlson Comorbidity Index (CCI) ≥1, and being unmarried were associated with increased DLBCL-specific death risk.
- Female sex and higher socioeconomic status showed a reduced risk of mortality.
- For patients receiving R-CHOP, 5-year survival suggests a potential cure point, with risks plateauing after 5 years.
Conclusions:
- Multistate modeling identified age, sex, and CCI as significant risk factors for mortality in older DLBCL patients.
- The study highlights the importance of considering competing risks in survival analyses for this demographic.
- R-CHOP therapy demonstrates a 5-year survival benefit, indicating a potential cure for older DLBCL patients.
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