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.

Xuejiao Yin,Yu Hu,Aoshuang Xu,Zhenli Huang,Chunyan Sun,Lu Zhang,Fengjuan Fan,Qianwen Cheng

doi:10.3389/fonc.2019.01198

Xuejiao Yin, Yu Hu + Show 6 more

Open Access

https://doi.org/10.3389/fonc.2019.01198

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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 15,882 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).Results: The extranodal DLBCL incidence continued to rise at a rate of 1.6% (95% CI, 0.4–2.8, p < 0.001) 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.Conclusions: 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. The prediction signature cloud identifies high-risk patients who should receive effective therapies to prevent the fatal nature of this disease, and low-risk patients to reduce over-treatment.

Highlights

Non-Hodgkin lymphoma (NHL) is the tenth most common cancer in the world in 2018 [1], while the most common NHL subtype is diffuse large B-cell lymphomas (DLBCL), comprising approximately 30% of NHL [2]
A total of 15,882 patients with extranodal DLBCL as the first malignancy diagnosed were included in the incidence analysis from SEER database from 1973 to 2015
The extranodal DLBCL incidence continued to rise at a rate of 1.6% per year over study period, until it declined around 2003 (Table 2)

Summary

Introduction

Non-Hodgkin lymphoma (NHL) is the tenth most common cancer in the world in 2018 [1], while the most common NHL subtype is diffuse large B-cell lymphomas (DLBCL), comprising approximately 30% of NHL [2]. Lymphoma can arise in any tissue, and approximately one third of patients present with extranodal sites [3]. There is increasing evidence that primary extranodal sites reflect distinct clinical features and prognostic implications, and require specific therapy [8, 9]. A new risk stratification signature that includes extranodal sites involved of origin is needed to guide the treatment of extranodal DLBCL. As a graphical expression of a mathematical model, nomographs could combine different information of several features to forecast a specific outcome in clinical practice. The nomograph has evolved into an important instrument for forecasting the clinical outcomes of various type of cancer and could provide optimal therapy schemes for physicians. DLBCL is the most commonly occurring type of non-Hodgkin’s lymphoma, which may be found at various extranodal sites. Little is known about the particular trends of extranodal DLBCL

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