Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?

Sandra Le Guyader-Peyrou (1, 2) , Sébastien Orazio (1, 2) , Olivier Dejardin (3) , Marc Maynadié (4, 5) , Xavier Troussard (6, 7) , Alain Monnereau (1, 2)

1 EPICENE - Cancer environnement
2 BPH - Bordeaux population health
3 Cancers et préventions
4 CEP - Centre d'épidémiologie des populations
5 Registre des hémopathies malignes de Côte d'Or
6 Registre des hémopathies malignes de Basse-Normandie [CHU Caen]
7 Laboratoire d'Hématologie Biologique [CHU Caen]

The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematology versus other), the time to travel to the nearest teaching hospital, the place of treatment (teaching versus not-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients' care in hematology/oncology departments.

Domaines: Hématologie

Sandra Le Guyader-Peyrou, Sébastien Orazio, Olivier Dejardin, Marc Maynadié, Xavier Troussard, et al.. Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?. Haematologica, 2017, 102 (3), pp.584-592. ⟨10.3324/haematol.2016.152918⟩. ⟨hal-01559872⟩