Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, 2101 McGavran-Greenberg Hall CB #7435, Chapel Hill, NC 27599-7435, United States of America.
AbbVie Inc., 1400 Sheridan Rd, North Chicago, IL, 60064, United States of America.
J Geriatr Oncol. 2023 Nov;14(8):101602. doi: 10.1016/j.jgo.2023.101602. Epub 2023 Sep 9.
While prognosis for patients with chronic lymphocytic leukemia (CLL) has improved over time in younger adults, only modest improvements have occurred in older adults. We conducted a descriptive study of prognosis in older adults with CLL.
We used data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database from 2003 to 2016. We identified older adults (≥66 years) diagnosed with primary CLL between 2004 and 2015 (Overall Cohort). A subset who initiated CLL-directed therapy during the year following diagnosis was also identified (Treated Cohort). Both cohorts were matched to Medicare beneficiaries without cancer based on age, sex, and region. For each year from 2004 to 2013, three-year survival for patients with CLL and non-cancer comparators was described using Kaplan-Meier analysis. Inverse probability weighted Cox regression models were used to compare survival in the CLL and non-cancer comparator cohorts, accounting for demographic information and comorbidity and frailty indices. Among older adults with CLL, ten-year cause-specific cumulative mortality was estimated using Aalen-Johansen estimators that accounted for competing risks. Predictors of cause-specific mortality, including comorbidity and frailty burden, were assessed using sub-distribution hazards models.
In the Overall Cohort, three-year survival increased non-monotonically from 71.4% in 2004 to 73.4% in 2013, with a peak of 74.4% in 2011, and was lower than survival in non-cancer comparators (78.3% in 2004 to 83.2% in 2013). In the Treated Cohort, three-year survival was 56.3% in 2004 and 56.5% in 2013, with a peak of 64.2% in 2011. Cox models suggested that survival in the Treated Cohort was approaching survival in non-cancer comparators after 2011 (hazard ratio = 1.04, 95% confidence interval, 0.93-1.17). Ten-year cumulative mortality was 68.6% in the Overall Cohort and 81.7% in the Treated Cohort, with most deaths attributed to non-CLL causes. In the sub-distribution hazards models, age, year of diagnosis, frailty, and comorbidities were all associated with prognosis.
Prognosis in older adults has been stable over time and most patients with CLL die from non-CLL causes. CLL-directed treatment decision-making in older adults should consider age-related factors, such as comorbidity and frailty.
虽然慢性淋巴细胞白血病（CLL）患者的预后在年轻患者中随着时间的推移而有所改善，但在老年患者中仅略有改善。我们对老年 CLL 患者的预后进行了描述性研究。
我们使用了 2003 年至 2016 年监测、流行病学和最终结果（SEER）-医疗保险数据库的数据。我们确定了在 2004 年至 2015 年期间被诊断为原发性 CLL 的老年患者（总体队列）。还确定了在诊断后一年内开始 CLL 定向治疗的亚组（治疗队列）。两个队列均根据年龄、性别和地区与没有癌症的医疗保险受益人相匹配。对于 2004 年至 2013 年的每一年，使用 Kaplan-Meier 分析描述 CLL 患者和非癌症对照者的三年生存率。使用逆概率加权 Cox 回归模型比较 CLL 和非癌症对照组的生存情况，同时考虑人口统计学信息、合并症和脆弱性指数。在患有 CLL 的老年患者中，使用 Aalen-Johansen 估计器估计十年特定原因累积死亡率，该估计器考虑了竞争风险。使用亚分布风险模型评估特定原因死亡率的预测因素，包括合并症和脆弱性负担。
在总体队列中，三年生存率从 2004 年的 71.4%非单调地增加到 2013 年的 73.4%，2011 年达到峰值 74.4%，低于非癌症对照者（2004 年为 78.3%，2013 年为 83.2%）。在治疗队列中，2004 年三年生存率为 56.3%，2013 年为 56.5%，2011 年达到峰值 64.2%。Cox 模型表明，2011 年后治疗队列的生存率接近非癌症对照组（风险比=1.04，95%置信区间，0.93-1.17）。总体队列的十年累积死亡率为 68.6%，治疗队列为 81.7%，大多数死亡归因于非 CLL 原因。在亚分布风险模型中，年龄、诊断年份、脆弱性和合并症均与预后相关。
老年患者的预后一直保持稳定，大多数 CLL 患者死于非 CLL 原因。老年患者的 CLL 定向治疗决策应考虑年龄相关因素，如合并症和脆弱性。
