title: Population-specific prognostic models are needed to stratify outcomes for African-Americans with diffuse large B-cell lymphoma.
abstract: Diffuse large B-cell lymphoma (DLBCL) demonstrates significant racial differences in age of onset, stage, and survival. To examine whether population-specific models improve prediction of outcomes for African-American (AA) patients with DLBCL, we utilized Surveillance, Epidemiology, and End Results data and compared stratification by the international prognostic index (IPI) in general and AA populations. We also constructed and compared prognostic models for general and AA populations using multivariable logistic regression (LR) and artificial neural network approaches. While the IPI adequately stratified outcomes for the general population, it failed to separate AA DLBCL patients into distinct risk groups. Our AA LR model identified age ≥ 55 (odds ratio 0.45, [95% CI: 0.36, 0.56], male sex (0.75, [0.60, 0.93]), and stage III/IV disease (0.43, [0.34, 0.54]) as adverse predictors of 5-year survival for AA patients. In addition, general-population prognostic models were poorly calibrated for AAs with DLBCL, indicating a need for validated AA-specific prognostic models.
authors.affiliation: a H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology , Atlanta , GA , USA ;
authors.forename: Qiushi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: a H. Milton Stewart School of Industrial & Systems Engineering, Georgia Institute of Technology , Atlanta , GA , USA ;
authors.forename: Turgay
authors.initials: T
authors.lastname: Ayer
authors.affiliation: b Department of Lymphoma/Myeloma, Division of Cancer Medicine , The University of Texas MD Anderson Cancer Center , Houston , TX , USA ;
authors.forename: Loretta J
authors.initials: LJ
authors.lastname: Nastoupil
authors.affiliation: c Department of Hematology/Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA ;
authors.forename: Jean L
authors.initials: JL
authors.lastname: Koff
authors.affiliation: c Department of Hematology/Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA ;
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Staton
authors.affiliation: d Department of Health Services Research , The University of Texas MD Anderson Cancer Center , Houston , TX , USA.
authors.forename: Jagpreet
authors.initials: J
authors.lastname: Chhatwal
authors.affiliation: c Department of Hematology/Oncology , Winship Cancer Institute, Emory University , Atlanta , GA , USA ;
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Flowers
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D005260:Female; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011379:Prognosis; D012306:Risk; D018426:SEER Program
keywords: Lymphoma; outcomes; prognostication; race; risk; survival