Incidence and Mortality Trends and Risk Prediction Nomogram for Extranodal Diffuse Large B-Cell Lymphoma: An Analysis of the Surveillance, Epidemiology and End Results Database

Abstract

Background: DLBCL is the most commonly occurring type of non-Hodgkin's lymphoma, which may be found at various extranodal sites. But little is known about the particular trends of extranodal DLBCL. Methods: A total of 15882 extranodal DLBCL patients were included in incidence analysis from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2015). The joinpoint regression software was used to calculate the annual percent change (APC) in rates. Nomograms were established by R software to predict overall survival (OS). Findings: The extranodal DLBCL incidence continued to rise at a rate of 1.6% (95% CI,0.4-2.8, p<.001) per year over the study period, until it declined around 2003. The incidence-based mortality trend of extranodal DLBCL had a similar pattern, with a decrease happening around 1993. Five-year survival rates improved dramatically from the 1970s to 2010s (44.15% vs 63.7%), and the most obvious increase occurred in DLBCL patients with primary site in the head/neck. The C-index showed a value for OS of 0.708, which validated the nomograms performed well and were able to forecast the prognosis of patients with extranodal DLBCL. The calibration curves showed satisfactory consistency between true values and predicted values for 1-, 5-, and 10-year overall survival, respectively. Interpretation: The incidence and incidence-based mortality of extranodal DLBCL had been increasing for decades, followed by a promising downward trend in recent years. These findings may help scientists identify disease-related risk factors and better manage the disease. Funding Statement: This work was supported by grants of the National Natural Science Foundation of China (No. 81670197 for Chunyan Sun; No. 81700206 for FJ Fan); and the Clinical Research Physician Program of Tongji Medical College, HUST (To CY.S); and the Integrated Innovative Team for Major Human Diseases Program of Tongji Medical College, HUST. Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: This study was fully compliance with the publication guidelines provided by SEER. The data were obtained from SEER, so the approval of ethics committee was not needed.