Racial differences in treatment and survival in older patients with diffuse large B-cell lymphoma (DLBCL).
Racial differences in treatment and survival in older patients with diffuse large B-cell lymphoma (DLBCL).
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DOI：
10.1186/1471-2407-10-625
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发表时间：
2010-11-12
期刊：
影响因子：
3.8
通讯作者：
Danese M
中科院分区：
文献类型：
--
作者：
Griffiths R;Gleeson M;Knopf K;Danese M
弥漫性大B细胞淋巴瘤（DLBCL）占美国淋巴瘤的31%。虽然它是一种侵袭性类型的淋巴瘤，但40%至50%的患者通过治疗治愈。研究目的是确定与DLBCL治疗和生存相关的患者因素。使用与医疗保险索赔相关的监测、流行病学和最终结果（SEER）登记数据，我们确定了2001年1月1日至2005年12月31日期间诊断为DLBCL的7，048例患者。从诊断开始对患者进行随访，直至其索赔史结束（最多2007年12月31日）或死亡。医疗保险索赔用于描述第一次输注的化学免疫疗法（C-I疗法）方案并识别辐射。进行多变量分析，以确定与治疗和生存相关的患者人口统计学、社会经济学和临床因素。生存分析中的结局变量为全因死亡率、非霍奇金淋巴瘤（NHL）死亡率和其他/不明原因死亡率。总体而言，84%（n = 5，887）在观察期内接受了C-I治疗或放疗：两者均为26%;单独C-I治疗为53%;单独放疗为5%。诊断时的中位年龄为77岁，54%为女性，88%为白色，43%在诊断时患有III或IV期疾病。首次治疗的中位时间为42天，92%的患者在诊断后第180天接受了首次治疗。在多变量分析中，≥ 80岁、黑人与白人、生活在贫困率≥ 12%的人口普查区和结外疾病患者的治疗率显著较低。与白人相比，黑人的总体治疗率较低（风险比[HR] 0.77; P < 0.001），并且在诊断后180天内接受治疗的可能性较低（比值比[OR] 0.63; P = 0.002）。在多变量生存分析中，黑人与较高的全因死亡率（HR 1.24; P = 0.01）和其他/未知原因死亡率（HR 1.35; P = 0.01）相关，但与NHL死亡率无关（HR 1.16; P = 0.19）。在诊断为DLBCL的老年患者中，黑人和白人在治疗途径和生存率方面存在很大差异。
Diffuse large B-cell lymphoma (DLBCL) comprises 31% of lymphomas in the United States. Although it is an aggressive type of lymphoma, 40% to 50% of patients are cured with treatment. The study objectives were to identify patient factors associated with treatment and survival in DLBCL. Using Surveillance, Epidemiology, and End Results (SEER) registry data linked to Medicare claims, we identified 7,048 patients diagnosed with DLBCL between January 1, 2001 and December 31, 2005. Patients were followed from diagnosis until the end of their claims history (maximum December 31, 2007) or death. Medicare claims were used to characterize the first infused chemo-immunotherapy (C-I therapy) regimen and to identify radiation. Multivariate analyses were performed to identify patient demographic, socioeconomic, and clinical factors associated with treatment and with survival. Outcomes variables in the survival analysis were all-cause mortality, non-Hodgkin's lymphoma (NHL) mortality, and other/unknown cause mortality. Overall, 84% (n = 5,887) received C-I therapy or radiation treatment during the observation period: both, 26%; C-I therapy alone, 53%; and radiation alone, 5%. Median age at diagnosis was 77 years, 54% were female, 88% were white, and 43% had Stage III or IV disease at diagnosis. The median time to first treatment was 42 days, and 92% of these patients had received their first treatment by day 180 following diagnosis. In multivariate analysis, the treatment rate was significantly lower among patients ≥ 80 years old, blacks versus whites, those living in a census tract with ≥ 12% poverty, and extra-nodal disease. Blacks had a lower treatment rate overall (Hazard Ratio [HR] 0.77; P < 0.001), and were less likely to receive treatment within 180 days of diagnosis (Odds Ratio [OR] 0.63; P = 0.002) than whites. In multivariate survival analysis, black race was associated with higher all-cause mortality (HR 1.24; P = 0.01) and other/unknown cause mortality (HR 1.35; P = 0.01), but not mortality due to NHL (HR 1.16; P = 0.19). In elderly patients diagnosed with DLBCL, there are large differences in treatment access and survival between blacks and whites.