Addition of Rituximab to Chemotherapy Reduced the Rate of Surgery for Gastric-DLBCL Without Increasing Early Mortality.
We evaluated surgical trends for gastric diffuse large B-cell lymphoma (gDLBCL) before and after the approval of rituximab and whether an association of early mortality existed in patients treated after approval of rituximab.



We utilized the Surveillance Epidemiology and End Results (SEER) 18 database to extract data on patients with gDLBCL diagnosed between 1983-2012. Primary site-specific cancer-directed surgery using SEER site-specific surgical codes and annual trends were analyzed. Patients were analyzed before and after 2006, the year rituximab gained U.S. Food and Drug Administration approval.



Joinpoint trend analysis showed the sharpest decline in surgical rates between 2000-2010. Adjusted surgical rates computed using poisson regression declined from 54.4% in 1983 to 6.9% in 2012, with an annual percentage change of -8.9% (95% confidence interval=-9.7% to -8.3%; p-value <0.01). No significant mortality increase at 30 and 60 days was found.



While rituximab appears to have significantly changed how surgery is utilized for patients with gDLBCL, early mortality was unchanged.
The West Cancer Center, Germantown, TN, U.S.A. pprouet@westclinic.com.|University of Tennessee Health Science Center Hematology/Oncology, Memphis, TN, U.S.A.
Philippe
P
Prouet
Department of Medical Oncology, Yale School of Medicine, New Haven, CT, U.S.A.
Smith
S
Giri
The West Cancer Center, Germantown, TN, U.S.A.|University of Tennessee Health Science Center Hematology/Oncology, Memphis, TN, U.S.A.
Eric
E
Wiedower
Blue Ridge Cancer Center, Salem, VA, U.S.A.
Andrew
A
Fintel
Keck Hospital of USC, Los Angeles, CA, U.S.A.
George
G
Yaghmour
Fox Chase Cancer Center, Temple Health, Philadelphia, PA, U.S.A.
Elena Paulus
EP
Lamb
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, U.S.A.
Jeremiah
J
Deneve
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, U.S.A.
Martin
M
Fleming
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, U.S.A.
Paxton
P
Dickson
The West Cancer Center, Germantown, TN, U.S.A.|University of Tennessee Health Science Center Hematology/Oncology, Memphis, TN, U.S.A.
Jason C
JC
Chandler
The West Cancer Center, Germantown, TN, U.S.A.|University of Tennessee Health Science Center Hematology/Oncology, Memphis, TN, U.S.A.
Mike G
MG
Martin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D000069283:Rituximab / Q000008:administration & dosage; D018426:SEER Program / Q000706:statistics & numerical data; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D014481:United States; D055815:Young Adult
D000069283:Rituximab
Neoplasia; chemotherapeutic/ immunotherapeutic approaches; lymphoma; prognostication