title: The impact of age on survival of diffuse large B-cell lymphoma - a population-based study.
abstract: BACKGROUND
  For Diffuse large B-cell lymphoma (DLBCL), the International Prognostic Index is the major tool for prognostication and considers an age above 60 years as a risk factor. However, there are several indications that increasing age is associated with more biological complexity, resulting in differences in DLBCL biology depending on age.
  
  
  METHODS
  We conducted a registry-based retrospective cohort study of all Swedish DLBCL patients diagnosed 2000-2013, to evaluate the importance of age at diagnosis for survival of DLBCL patients.
  
  
  RESULTS
  In total, 7166 patients were included for further analysis. Survival declined for every 10-year age group and every age group above the age of 39 had a statistically decreased survival compared to the reference group of 20-29 years. In an analysis of relative survival, and in a multifactorial model adjusted for stage, ECOG performance status, serum lactate dehydrogenase and involvement of extranodal sites, each age group above age 39 had a significantly higher risk ratio (p=0.01) compared to the reference group.
  
  
  CONCLUSIONS
  This is one of the largest population-based studies of DLBCL published to date. In this study, age persisted as a significant adverse risk factor for patients as young as 40 years, even after adjustment for other risk factors.
authors.affiliation: Department of Radiology, Oncology, and Radiation Sciences, Uppsala University , Uppsala , Sweden.
authors.forename: Gustaf
authors.initials: G
authors.lastname: Hedström
authors.forename: Oskar
authors.initials: O
authors.lastname: Hagberg
authors.forename: Mats
authors.initials: M
authors.lastname: Jerkeman
authors.forename: Gunilla
authors.initials: G
authors.lastname: Enblad
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011241:Prednisone / Q000627:therapeutic use; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D000069283:Rituximab / Q000008:administration & dosage; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000069283:Rituximab; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone