Non-cancer-specific survival in patients with primary central nervous system lymphoma: A multi-center cohort study

Abstract

ObjectiveThe study aimed to evaluate the non-cancer-specific death risk and identify the risk factors affecting the non-cancer-specific survival (NCSS) in patients with primary central nervous system lymphoma (PCNSL).MethodsThis multi-center cohort study included 2497 patients with PCNSL in the Surveillance, Epidemiology and End Results (SEER) database from 2007 to 2016, with a mean follow-up of 4.54 years. The non-cancer-specific death risk in patients with PCNSL and primary central nervous system diffuse large B-cell lymphoma (PCNS-DLBCL) was evaluated using the proportion of deaths, standardized mortality ratio (SMR), and absolute excess risk (AER). Univariate and multivariate competing risk regression models were utilized to identify the risk factors of NCSS.ResultsPCNSL was the most frequent cause of death in PCNSL patients (75.03%). Non-cancer-specific causes constituted a non-negligible portion of death (20.61%). Compared with the general population, PCNSL patients had higher risks of death from cardiovascular disease (CVD) (SMR, 2.55; AER, 77.29), Alzheimer’s disease (SMR, 2.71; AER, 8.79), respiratory disease (SMR, 2.12; AER, 15.63), and other non-cancer-specific diseases (SMR, 4.12; AER, 83.12). Male sex, Black race, earlier year of diagnosis (2007–2011), being unmarried, and a lack of chemotherapy were risk factors for NCSS in patients with PCNSL and PCNS-DLBCL (all P < 0.05).ConclusionNon-cancer-specific causes were important competing causes of death in PCNSL patients. More attention is recommended to non-cancer-specific causes of death in the management of PCNSL patients.

Age-related differences in primary central nervous system lymphomas based on the SEER database

“…Based on our large population analysis, radiotherapy was associated with better DSM in both PCNS-DLBCL cohorts in this study. It is noteworthy that in the older cohort, radiotherapy signi cantly improved OS, which differs from the ndings of Tang et al [13] . The possible reasons for this difference include that older people may be more likely to undergo stereotactic body radiation therapy or stereotactic ablative radiotherapy for radiation treatment with less side effects due to their age and medical condition, whereas younger people are more likely to undergo WBRT.…”

“…In a recent study, a large cohort of 5166 PCNSL patients was evaluated based on the Surveillance, Epidemiology, and End Results (SEER) database, and it was reported that race, sex, age, marital status, surgical resection, and chemotherapy were independent prognostic factors for OS [12] . In another study, the risk factors for non-cancer-speci c survival in PCNSL patients were male sex, black race, unmarried status, and a lack of chemotherapy [13] . However, these previous studies did not directly compare the differences in prognosis and treatment options between younger and older PCNSL patients.…”