The impact of race, age, and sex in follicular lymphoma: A comprehensive SEER analysis across consecutive treatment eras

Abstract

The impact of race/ethnicity and the additional factors of age, sex, and socioeconomic status (SES) on follicular lymphoma (FL) outcomes have not been comprehensively studied and are not well defined. We examined population-based FL data from >18,000 patients in SEER-13 (1992-2009) investigating race/ethnicity and the impact of relevant factors including sex, age, and SES. Further, we compared data over two consecutive periods: Era-1 (1992-2000, n = 8,355) and Era-2 (2001-2009, n = 10,475). We identified 18,830 FL patients (White: n = 15,116; Hispanic: n = 1,627; Asian/Pacific Islander (A/PI): n = 1,002; and Black: n = 846). Median ages (years) differed significantly by race/ethnicity: White: 62.1, Hispanic: 57.3, A/PI: 60.7, and Black: 56.8 (P < 0.01 each race versus White). Overall survival (OS) was superior in Era-2 versus Era-1 for all patients (5-year: 76.7% versus 67.4%, respectively, P < 0.001). Further, survival was significantly improved for all age groups <80 years, for males (P = 0.0019), and females (P < 0.001) across eras. Females had superior OS compared with males in Era-1 (P = 0.004), but not in Era-2. Additionally, all races, except A/PI, had improved 5-year OS rates from Era-1 to Era-2. Finally, OS improved across eras for lower and higher SES populations; however those with higher SES were superior to lower SES patients in both eras. In conclusion, and in the largest comprehensive evaluation of US-based FL patients to date, we show that despite improvements in OS for FL over time, critical disparities across races/ethnicities, sex, and age groups remain in the modern era and warrant further studies.

Impact of treatment in long-term survival patients with follicular lymphoma: A Spanish Lymphoma Oncology Group registry

“…This finding is consistent with data from American [28, 29] and European [30] studies, ours being the largest study of all the ones published in our continent that can be related to the introduction of R. It has been speculated whether the improvements achieved in support care or even high doses of chemotherapy may have influenced this.…”

Prognostic value of event‐free survival at 12 and 24 months and long‐term mortality for non‐Hodgkin follicular lymphoma patients: A study report from the Spanish Lymphoma Oncology Group

“…[11][12][13] However, a constant concern with these tumors with long survival times and many treatments is that overall mortality, in comparison with that of a sex-and agematched general population, is always much higher, as occurs with Hodgkin lymphoma. We observed increases in the OS of patients over the years and diagnostic periods, and they were identifiable for all age and sex groups, including groups at advanced stages.…”

Disease, treatment, and outcome differences between men and women with follicular lymphoma in the United States

“…In a cohort of 110 FL patients treated with chemoimmunotherapy, female patients had better PFS (68% vs. 52% at 4 years; P = 0.036); reasons for this advantage were not identified [19]. A retrospective analysis of the SEER database showed that both males and females experienced improved OS in the contemporary era [20]. Nonetheless, when the sexes were compared, the advantage that females enjoyed before 2002 was mitigated in subsequent years; no data on differences according to age were provided.…”