Cancer Res Treat.  2021 Jan;53(1):270-278. 10.4143/crt.2020.626.

Prognostic Impact of Age at the Time of Diagnosis in Korean Patients with Diffuse Large B-cell Lymphoma in the Rituximab Era: A Single Institution Study

• Hwang HS
• Kim M
• Park CS
• Yoon DH
• Suh C
• Huh J
• Go H

• KMID: 2510669
• DOI: http://doi.org/10.4143/crt.2020.626

Abstract

Purpose
In contrast to the Western diffuse large B-cell lymphoma (DLBCL), prognostic impact of age in a Korean population with DLBCL has not been fully evaluated.
Materials and Methods
Six hundred and eight DLBCL patients treated with rituximab-containing chemotherapeutic regimens from January 2002 to March 2012 in Asan Medical Center were enrolled. Survival models using the restricted cubic spine−transformed age variable were constructed to evaluate non-linear relationships between age and survival outcome. Finally, age was categorized according to the conventional international prognostic index (IPI), National Comprehensive Cancer Network (NCCN)-IPI, and Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea (GELTAMO)-IPI schemes and the prognostic implications were evaluated.
Results
The relative hazard did not change significantly during the first to fifth decades, but began to increase exponentially in patients aged over 62 years. This pattern or relationship was also retained in a multivariate model fitted to the age-adjusted IPI and relative dose intensity. Multivariate survival analysis revealed that age > 75 years, but not age > 60 years, was associated independently with poor overall and progression-free survival when the relative dose intensity and age-adjusted IPI were taken into account.
Conclusion
The outcome of DLBCL in Korean populations may deteriorate rapidly as age exceeds 62 years. Therefore, a consensus cutoff value for age in Korean DLBCL patients should be determined to better predict prognosis.

Keyword

Diffuse large B-cell lymphoma; Age; Prognosis; Statistical model

Figure

• 

  Fig. 1 Relationship between patient age and survival outcome. (A, B) Martingale residual plots from null Cox proportional hazard (PH) models for overall survival (OS) (A) and progression-free survival (PFS) (B), with scatterplot smoothing lines showing a rapid increasing pattern of smoothened Martingale residuals (indicating relative hazards) as age exceeded 62 years. (C, D) Martingale residual plots for multivariate Cox PH models fitted according to age-adjusted international prognostic index, presence of B symptoms, and average relative dose intensity for OS (C) and PFS (D). Plots show scatterplot smoothing lines with similar patterns to those in (A) and (B). (E, F) Univariate relative hazard plots for restricted cubic spline–transformed age variables for OS (E) and PFS (F) displaying the patterns identical to those of the scatterplot smoothing lines shown in (A) and (B). The gray areas denote 95% confidence intervals, and the interrupted vertical lines indicate age of 62 years.

• 

  Fig. 2 Kaplan-Meier survival analyses for age variables categorized according to known cutoff criteria. (A, B) Age variables for the conventional IPI. (C, D) Age variables for the NCCN-IPI. (E, F) Age variables for the GELTAMO-IPI. GELTAMO, Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea; IPI, International Prognostic Index; NCCN, National Comprehensive Cancer Network.

Reference

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