Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA.
Cancer Med. 2021 Feb;10(4):1327-1334. doi: 10.1002/cam4.3736. Epub 2021 Jan 27.
The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B-cell lymphoma (DLBCL) patients.
We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I-IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model.
Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HR 1.51; 95% CI: 1.02-2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93-2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22-2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39-4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80-5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I-III HR 0.34, CI 0.18-0.64, p < 0.001; HR 0.50, CI 0.30-0.82, p = 0.006, HR 0.72, CI 0.43-1.13, p = 0.152, respectively).
Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.
本研究旨在探讨种族与儿科弥漫性大 B 细胞淋巴瘤（DLBCL）患者总生存（OS）差异相关的因素。
我们利用多变量 Cox 比例风险模型，从国家癌症数据库（NCDB）中评估了 2004 年至 2014 年间年龄≤21 岁、诊断为 I-IV 期 DLBCL 的患者的临床特征和生存情况。
在 1386 名患有 DLBCL 的儿科患者中，有 1023 名患者符合入选标准。在未调整分析中，黑人患者的总死亡率明显高于白人患者（HR 1.51；95%CI：1.02-2.23，p=0.041）。尽管调整了协变量，但调整分析中生存差异并不显著，且调整幅度对差异大小影响不大（HR 1.46；95%CI 0.93-2.31，p=0.103）。在调整后的模型中，B 症状的存在、化疗的接受、疾病的分期和其他保险与 OS 显著相关。具体来说，有 B 症状的患者和其他保险的患者比没有 B 症状或私人保险的患者更有可能死亡（HR 1.75；95%CI 1.22-2.50，p=0.002）和（HR 2.56；95%CI，1.39-4.73，p=0.0027），未接受化疗的患者比接受化疗的患者死亡风险高三倍（HR 3.10；CI 1.80-5.35，p<0.001），分期较早的患者比患有 IV 期疾病的患者死于疾病的风险低（I-III 期 HR 0.34，CI 0.18-0.64，p<0.001；HR 0.50，CI 0.30-0.82，p=0.006，HR 0.72，CI 0.43-1.13，p=0.152）。
我们的研究结果表明，生存方面的种族差异可能是由临床和治疗参数介导的。
