title: Factors related to the relative survival of patients with diffuse large B-cell lymphoma in a population-based study in France: does socio-economic status have a role?
abstract: The survival of patients with diffuse large B-cell lymphoma has increased during the last decade as a result of addition of anti-CD20 to anthracycline-based chemotherapy. Although the trend is encouraging, there are persistent differences in survival within and between the USA and European countries suggesting that non-biological factors play a role. Our aim was to investigate the influence of such factors on relative survival of patients with diffuse large B-cell lymphoma. We conducted a retrospective, multicenter, registry-based study in France on 1165 incident cases of diffuse large B-cell lymphoma between 2002 and 2008. Relative survival analyses were performed and missing data were controlled with the multiple imputation method. In a multivariate analysis, adjusted for age, sex and International Prognostic Index, we confirmed that time period was associated with a better 5-year relative survival. The registry area, the medical specialty of the care department (onco-hematologyversusother), the time to travel to the nearest teaching hospital, the place of treatment (teachingversusnot-teaching hospital -borderline significance), a comorbidity burden and marital status were independently associated with the 5-year relative survival. Adjusted for first-course treatment, inclusion in a clinical trial and treatment discussion in a multidisciplinary meeting were strongly associated with a better survival outcome. In contrast, socio-economic status (determined using the European Deprivation Index) was not associated with outcome. Despite therapeutic advances, various non-biological factors affected the relative survival of patients with diffuse large B-cell lymphoma. The notion of lymphoma-specific expertise seems to be essential to achieve optimal care management and reopens the debate regarding centralization of these patients' care in hematology/oncology departments.
authors.affiliation: Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France s.leguyaderpeyrou@bordeaux.unicancer.fr.|University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Le Guyader-Peyrou
authors.affiliation: Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.|University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Orazio
authors.affiliation: University Hospital of Caen, U1086 INSERM UCBN «Cancers & Préventions», France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Dejardin
authors.affiliation: Registre des Hémopathies Malignes de Côte d'Or, EA4184, Université de Bourgogne, Dijon, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Maynadié
authors.affiliation: Registre des Hémopathies Malignes de Basse Normandie, Caen, France.|Laboratoire d'Hématologie, CHU de Caen, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Troussard
authors.affiliation: Registre des Hémopathies Malignes de la Gironde, Institut Bergonie, Bordeaux, France.|University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, F-33000, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Monnereau
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015897:Comorbidity; D005163:Factor Analysis, Statistical; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D011159:Population Surveillance; D011379:Prognosis; D012042:Registries; D012923:Social Class; D016019:Survival Analysis; D055815:Young Adult