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Associations between race and survival in pediatric patients with diffuse large B-cell lymphoma
Karishma Khullar1, Jesse J Plascak2, Richard Drachtman3
1Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Insights
Racial disparities in pediatric diffuse large B-cell lymphoma (DLBCL) survival may be linked to clinical factors and treatment. Further research is needed to address these survival differences in DLBCL patients.
Area of Science:
- Pediatric Oncology
- Hematology
- Cancer Epidemiology
Background:
- Pediatric diffuse large B-cell lymphoma (DLBCL) presents unique survival challenges.
- Racial disparities in cancer outcomes are a significant public health concern.
- Understanding factors influencing survival in pediatric DLBCL is crucial for equitable care.
Purpose of the Study:
- To investigate the factors contributing to racial disparities in overall survival (OS) among pediatric diffuse large B-cell lymphoma (DLBCL) patients.
- To analyze the impact of clinical features and treatment on survival differences by race in this population.
Main Methods:
- Utilized data from the National Cancer Database (NCDB) for pediatric patients (≤21 years) diagnosed with DLBCL between 2004 and 2014.
- Employed multivariable Cox proportional hazards models to evaluate clinical characteristics and survival.
- Included 1023 eligible patients in the final analysis.
Main Results:
- Unadjusted analysis indicated a higher death rate in Black patients compared to White patients (HR 1.51, p=0.041).
- Adjusted analysis showed this disparity was not statistically significant (HR 1.46, p=0.103), suggesting mediation by other factors.
- Key OS predictors included B symptoms, chemotherapy receipt, disease stage, and insurance type. Patients with B symptoms, "Other" insurance, or no chemotherapy had worse survival. Earlier stage disease correlated with better survival.
Conclusions:
- Racial disparities in pediatric DLBCL survival may be influenced by clinical and treatment-related parameters.
- These findings highlight the need to address disparities in care delivery and access to treatment.
- Further investigation into specific mediating factors is warranted to improve outcomes for all pediatric DLBCL patients.
Background:
The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B-cell lymphoma (DLBCL) patients.
Methods:
We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I-IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model.
Results:
Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.51; 95% CI: 1.02-2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93-2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22-2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39-4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80-5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I-III HR 0.34, CI 0.18-0.64, p < 0.001; HR 0.50, CI 0.30-0.82, p = 0.006, HR 0.72, CI 0.43-1.13, p = 0.152, respectively).
Conclusions:
Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.
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