Influence of age on long-term net survival benefit for early-stage MALT lymphomas treated with radiotherapy: A SEER database analysis (2000–2015). (August 2022)

• Record Type: Journal Article
• Authors: Wu, Yunpeng; Liu, Xin; Imber, Brandon S.; Zhong, Qiu-Zi; Yang, Yong; Wu, Tao; Chen, Si-Ye; Chen, Bo; Song, Yong-Wen; Fang, Hui; Jin, Jing; Liu, Yue-Ping; Jing, Hao; Tang, Yuan; Li, Ning; Lu, Ning-Ning; Wang, Shu-Lian; Chen, Fan; Yin, Lin; Zhang, Xi-Mei; Zhu, Jingru; Tsang, Richard W.; Yahalom, Joachim; Hu, Chen; Men, Kuo; Deng, Min; Xia, Changfa; Li, Ye-Xiong; Qi, Shu-Nan
• Is Part Of: Radiotherapy and oncology. Volume 173(2022)
• Page Start: 179
• Page End: 187
• Publication Date: 2022-08
• Subjects: SEER surveillance, epidemiology, and end results -- ICD international classification of diseases -- CI confidence interval -- HR hazard ratio -- IPTW inverse probability of treatment weighting -- SMR standardized mortality ratio -- RS relative survival; MALT lymphoma -- Radiotherapy -- Relative survival -- Age; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2022.05.034
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Radiotherapy was associated with better long-term net survival in patients with early-stage MALT lymphoma. This association was seen all ages up to 90 years. The relative survival benefit associated with radiotherapy was higher in younger patients. Abstract: Background: Given the lower incidence of lymphoma-related death but higher background mortality in patients with early-stage mucosa-associated lymphoid tissue (MALT) lymphoma, it is critically important to examine how age affects a treatment's survival benefit. Methods: 9, 467 patients with early-stage MALT lymphoma in the Surveillance, Epidemiology, and End Results (SEER) database treated between 2000–2015 were extracted and analyzed. Primary therapy was classified as radiotherapy (n = 3, 407), chemotherapy (n = 1, 294), and other/unknown treatments including observation (n = 4, 766). Inverse probability of treatment weighting (IPTW) was conducted to balance baseline characteristics between groups. Relative survival (RS), standardized mortality ratio (SMR), and transformed Cox regression were conducted to compare survival differences between treatment modalities by controlling for the background mortality. Radiotherapy–age interaction was examined. Results: Across age-groups, early-stage MALT lymphoma patients were at lower risk of lymphoma-related death than death due to other causes. The 10-year overall survival (OS, 73.8 %) and RS (96.6 %) rates were significantly higher, and the SMR (1.14) significantly lower, with radiotherapy than with chemotherapy (OS, 61.7 %; RS, 86.4 %; SMR, 1.54; P < 0.001) or other/unknown treatments (OS, 61.1 %; RS, 87.2 %; SMR, 1.41; P < 0.001). By multivariable analysis and IPTW, radiotherapy remained an independent predictor of better RS (HR 0.81, 95 %CI, 0.73–0.89; P < 0.001). A significant interaction between age and radiotherapy was identified for both RS ( P interaction = 0.016) and OS ( P interaction = 0.024), indicating greater benefit in young adults. Conclusion: Radiotherapy was associated with significantly better survival in early-stage MALT lymphoma, especially in young adults.