TY - JOUR
T1 - Associations between race and survival in pediatric patients with diffuse large B-cell lymphoma
AU - Khullar, Karishma
AU - Plascak, Jesse J.
AU - Drachtman, Richard
AU - Cole, Peter D.
AU - Parikh, Rahul R.
N1 - Publisher Copyright: © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
PY - 2021/2
Y1 - 2021/2
N2 - Background: The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B-cell lymphoma (DLBCL) patients. Methods: We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I–IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model. Results: Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.51; 95% CI: 1.02–2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93–2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22–2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39–4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80–5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I–III HR 0.34, CI 0.18–0.64, p < 0.001; HR 0.50, CI 0.30–0.82, p = 0.006, HR 0.72, CI 0.43–1.13, p = 0.152, respectively). Conclusions: Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.
AB - Background: The purpose of this study was to examine the factors associated with disparities in overall survival (OS) by race in pediatric diffuse large B-cell lymphoma (DLBCL) patients. Methods: We evaluated clinical features and survival among patients ≤21 years of age diagnosed with stage I–IV DLBCL from 2004 to 2014 from the National Cancer Database (NCDB) using a multivariable Cox proportional hazards model. Results: Among 1386 pediatric patients with DLBCL, 1023 patients met eligibility criteria. In unadjusted analysis, Black patients had a significantly higher overall death rate than White patients (HRBlack vs. White 1.51; 95% CI: 1.02–2.23, p = 0.041). The survival disparity did not remain significant in adjusted analysis, though controlling for covariates had little effect on the magnitude of the disparity (HR 1.46; 95% CI 0.93–2.31, p = 0.103). In adjusted models, presence of B symptoms, receipt of chemotherapy, stage of disease, and Other insurance were significantly associated with OS. Specifically, patients with B symptoms and those with Other insurance were more likely to die than those without B symptoms or private insurance, respectively (HR 1.75; 95% CI 1.22–2.50, p = 0.002) and (HR 2.56; 95% CI, 1.39–4.73, p = 0.0027), patients who did not receive chemotherapy were three times more likely to die than those who received chemotherapy (HR 3.10; CI 1.80–5.35, p < 0.001), and patients who presented with earlier stage disease were less likely to die from their disease than those with stage IV disease (stages I–III HR 0.34, CI 0.18–0.64, p < 0.001; HR 0.50, CI 0.30–0.82, p = 0.006, HR 0.72, CI 0.43–1.13, p = 0.152, respectively). Conclusions: Our results suggest that racial disparities in survival may be mediated by clinical and treatment parameters.
KW - diffuse large B-cell lymphoma
KW - health-care disparities
KW - non-Hodgkin lymphoma
KW - race
KW - survival
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U2 - https://doi.org/10.1002/cam4.3736
DO - https://doi.org/10.1002/cam4.3736
M3 - Article
C2 - 33503323
VL - 10
SP - 1327
EP - 1334
JO - Cancer Medicine
JF - Cancer Medicine
SN - 2045-7634
IS - 4
ER -