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Published on: October 2, 2015
Age-related early mortality and competing-risk outcomes in angioimmunoblastic T-cell lymphoma: a SEER-based
Yingdan Huang1, Chang Xue1, Hao Lei2
1Department of Lymphoma Medicine, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 116 Zhuodaoquan South Road, Hongshan District, Wuhan, Hubei, 430079, China.
Background:
Angioimmunoblastic T-cell lymphoma (AITL) predominantly affects older adults, but the distribution of deaths soon after diagnosis between lymphoma and competing causes is uncertain, particularly in octogenarian patients.
Methods:
We analyzed patients with AITL in the SEER 17 Registries database. The stage-adjusted main cohort included diagnoses from 2000 to 2015; a stage-unadjusted sensitivity cohort extended through 2021. Patients aged <60 years served as the reference group. Fixed-window logistic regression, Kaplan-Meier and Cox analyses, cumulative incidence functions, Fine-Gray models, and cause-specific Cox models were used. Deaths with unknown cause were retained as a third competing event.
Results:
Among 1,516 patients, recorded chemotherapy use decreased from 83.7% at age <60 years to 52.2% at age ≥80 years, while 6-month mortality increased from 13.5% to 41.6%. In octogenarian patients, 91 AITL-specific deaths (35.7% of the age group), 15 non-AITL deaths (5.9%), and no unknown-cause deaths occurred within 6 months; AITL-specific deaths comprised 85.8% of recorded 6-month deaths. Relative to age <60 years, age ≥80 years was associated with 6-month all-cause mortality (OR 3.890, 95% CI 2.628-5.756), AITL-specific death (sHR 2.034, 95% CI 1.645-2.516), and non-AITL death (sHR 3.663, 95% CI 2.399-5.594). Stage-unadjusted analyses through 2021 showed similar age gradients.
Conclusions:
Early mortality increased sharply with age in AITL. Most recorded early deaths among octogenarian patients were classified as AITL-specific, while competing non-AITL mortality also increased. These findings support prompt lymphoma assessment, geriatric evaluation, and treatment planning that jointly considers disease control and competing risks.