Wang Fan
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, The People's Republic of China.
J Cancer Surviv. 2025 May 28. doi: 10.1007/s11764-025-01839-9.
Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) predominantly affects older adults and is characterized by a prolonged disease course. While overall survival has improved, the psychosocial burden, including suicide risk, remains underexplored. METHODS: A retrospective cohort study was conducted using data from 95,517 patients diagnosed with CLL/SLL between 2000 and 2021 from the SEER 17 registry. LASSO regression was utilized for variable selection, followed by univariate and multivariate Cox proportional hazards and Fine-Gray competing risk analyses to identify independent predictors. A nomogram was developed based on significant predictors and validated using time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). RESULTS: The cohort's mean age was 69.2 years, with 21.6% aged ≥ 80 years and a male-to-female ratio of 1.5:1; 88.8% were White. Although the suicide rate was low (0.1%), multivariate analysis showed that male sex, non-married status, lower income, and White race were significantly associated with increased suicide risk. Advanced age (≥ 80) was significant in Cox but not in competing risk models. The nomogram demonstrated good predictive accuracy (AUC > 0.71 at 3, 5, and 10 years) and clinical utility.
Sociodemographic factors, including sex, race, marital status, and income, are independently associated with suicide risk in CLL/SLL patients. The developed nomogram offers a practical, evidence-based tool for early identification of high-risk individuals, thereby facilitating targeted psychosocial interventions and improving survivorship care.
CLL/SLL survivors who are male, unmarried, or of lower socioeconomic status face heightened suicide risk, highlighting the critical need for tailored psychosocial support within survivorship care.
慢性淋巴细胞白血病/小淋巴细胞淋巴瘤（CLL/SLL）主要影响老年人，其病程较长。虽然总体生存率有所提高，但包括自杀风险在内的心理社会负担仍未得到充分研究。
利用监测、流行病学和最终结果（SEER）17登记处2000年至2021年间诊断为CLL/SLL的95517例患者的数据进行回顾性队列研究。采用套索回归进行变量选择，随后进行单变量和多变量Cox比例风险分析以及Fine-Gray竞争风险分析，以确定独立预测因素。基于显著预测因素开发了列线图，并使用时间依赖性受试者工作特征（ROC）曲线、校准图和决策曲线分析（DCA）进行验证。
该队列的平均年龄为69.2岁，其中21.6%的患者年龄≥80岁，男女比例为1.5:1；88.8%为白人。虽然自杀率较低（0.1%），但多变量分析显示，男性、未婚状态、低收入和白人种族与自杀风险增加显著相关。高龄（≥80岁）在Cox模型中具有显著性，但在竞争风险模型中不显著。列线图显示出良好的预测准确性（3年、5年和10年时的AUC>0.71）和临床实用性。
社会人口学因素，包括性别、种族、婚姻状况和收入，与CLL/SLL患者的自杀风险独立相关。所开发的列线图为早期识别高危个体提供了一种实用的、基于证据的工具，从而有助于进行有针对性的心理社会干预并改善生存护理。
男性、未婚或社会经济地位较低的CLL/SLL幸存者面临更高的自杀风险，这凸显了在生存护理中提供量身定制的心理社会支持的迫切需求。
