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Comparative Outcomes Between Black and White Patients With Early-Stage Diffuse Large B-Cell Lymphoma
María Herrán1, Sindu Iska2, Hong Liang3
1Department of Hematology and Oncology, Maroone Cancer Center, Cleveland Clinic Florida, Weston, Florida, USA.
Introduction:
Determinants of survival in DLBCL stage I-IV collectively have reported Black patients and advanced stage to have worse outcomes on multivariate analysis. As advanced stage is a factor in outcome, available data have not focused on early-stage DLBCL to evaluate the impact of race and SES on outcome. To address this research gap, the study aims to examine and compare the characteristics and the determinants of survival between US Black and White patients with early-stage (I-II) DLBCL.
Methods:
A retrospective NCDB analysis of early-stage DLBCL patients was conducted, comparing sociodemographic, clinical, and treatment factors between Black and White groups. Chi-square tests assessed differences. Multivariate Cox regression identified survival predictors. Matched patient pairs were analyzed using Cox models with robust variance, and Kaplan-Meier curves evaluated survival outcomes by race.
Results:
81,430 early-stage DLBCL patients diagnosed between 2004 and 2017 included 5,709 Black and 75,721 White patients. Multivariate analysis showed higher mortality risk for males (HR 1.09), aged ≥ 60 (HR 2.04), ≥ 2 comorbidities (HR 1.92), B symptoms (HR 1.23), HIV infection (HR 1.59), and lower income (HR 1.18) (all p < 0.0001). Notably, survival rates between Black and White patients were not significantly different (HR 0.98, p = 0.5263).
Conclusion:
Black patients have been reported to have worse survival for DLBCL, considering all stages collectively. The remarkable finding of our study was that despite disparities in socioclinical determinants, no overall survival difference was observed between Black and White patients with early-stage DLBCL. We suggest that the similar survival in early-stage DLBCL for Black and White patients is primarily overcome by the favorable remission rate of early-stage DLBCL and accessibility to conventional chemoimmunotherapy. We also imply that the survival disparity between Black and White patients in DLBCL is more likely to be the impact of socioclinical determinants on advanced stage III/IV DLBCL.
