老年弥漫性大 B 细胞淋巴瘤（DLBCL）患者治疗和生存的种族差异。
Racial differences in treatment and survival in older patients with diffuse large B-cell lymphoma (DLBCL).
机构信息
Outcomes Insights, Inc,, Westlake Village, CA, USA.
出版信息
BMC Cancer. 2010 Nov 12;10:625. doi: 10.1186/1471-2407-10-625.
BACKGROUND
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.
METHODS
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.
RESULTS
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).
CONCLUSIONS
In elderly patients diagnosed with DLBCL, there are large differences in treatment access and survival between blacks and whites.
背景
弥漫性大 B 细胞淋巴瘤（DLBCL）占美国淋巴瘤的 31%。尽管它是一种侵袭性淋巴瘤，但 40%至 50%的患者可以通过治疗治愈。本研究旨在确定与 DLBCL 患者治疗和生存相关的患者因素。
方法
使用监测、流行病学和最终结果（SEER）登记数据与医疗保险索赔数据进行链接，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 7048 例患者。患者从诊断开始随访至其索赔记录结束（最长至 2007 年 12 月 31 日）或死亡。医疗保险索赔用于描述首次输注的化疗免疫治疗（C-I 治疗）方案，并确定放疗。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/未知原因死亡率。
结果
总体而言，84%（n=5887）在观察期间接受了 C-I 治疗或放疗：两者均为 26%；C-I 治疗单独治疗，占 53%；单独放疗，占 5%。诊断时的中位年龄为 77 岁，54%为女性，88%为白人，43%在诊断时患有 III 期或 IV 期疾病。首次治疗的中位时间为 42 天，92%的患者在诊断后 180 天内接受了首次治疗。多变量分析显示，≥80 岁、黑人而非白人、居住在贫困率≥12%的普查区和结外疾病的患者治疗率显著较低。黑人总体上的治疗率较低（风险比[HR]0.77；P<0.001），并且比白人更不可能在诊断后 180 天内接受治疗（优势比[OR]0.63；P=0.002）。在多变量生存分析中，黑人种族与全因死亡率（HR 1.24；P=0.01）和其他/未知原因死亡率（HR 1.35；P=0.01）较高相关，但与 NHL 死亡率（HR 1.16；P=0.19）无关。
结论
在诊断为 DLBCL 的老年患者中，黑人和白人在治疗机会和生存方面存在很大差异。
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