The impact of age on survival of diffuse large B-cell lymphoma – a population-based study

Figures & data

Table I. Clinical characteristics of DLBCL in Sweden 2000–2013.

Age (y)	All no.	20–29 %	30–39 %	40–49 %	50–59 %	60–69 %	70–79 %	80–89 %	90–99 %
n	7165	101	208	431	957	1775	2046	1472	175
Incidence rate/year/100 000	7.3	0.6	1.2	2.5	5.7	12.4	21.4	25.8	16.6
Mean age (y)	68	26	35	45	55	65	75	84	92
Median survival		–	–	–	–	11.6 y	4.2 y	1.2 y	0.3 y
Sex
Men % (n)	55.0 (3943)	56.4 (57)	56.3 (117)	61.3 (264)	60.0 (574)	58.4 (1036)	55.9 (1144)	46.4 (683)	38.9 (68)
Women % (n)	45.0 (3222)	43.6 (44)	43.7 (91)	38.7 (167)	40.0 (383)	41.6 (739)	44.1 (902)	53.6 (789)	61.1 (107)
Stage
I	1514	27.7	25.5	27.8	21.7	21.2	20.2	19.1	19.4
II	1679	31.7	27.9	24.8	24.9	22.5	23.0	22.8	21.2
III	1191	16.8	16.4	14.9	18.5	17.8	17.4	14.3	10.3
IV	2471	23.8	28.8	30.9	33.8	37.1	36.4	33.1	23.4
NA	310		1.4	1.6	1.1	1.4	3.0	10.7	25.7
S-LDH
Normal	2733	41.6	51.0	42.0	37.6	35.6	40.9	35.7	36.0
High	3971	55.4	45.2	55.4	57.7	60.8	53.3	53.1	37.7
NA	461	3.0	3.8	2.6	4.7	3.6	5.8	11.2	26.3
ECOG PS
0	2750	49.5	56.3	56.4	50.6	44.7	34.4	22.5	16.6
1	2410	31.7	31.7	28.1	31.1	33.1	34.6	36.5	34.9
2	801	7.9	5.3	7.7	7.6	9.5	12.8	15.1	13.1
3	678	4.0	3.8	3.9	4.6	7.8	10.4	14.5	22.9
4	372	2.0	2.4	2.6	4.3	3.4	6.2	7.6	7.4
NA	154	4.9	0.5	1.0	1.8	1.5	1.6	3.8	5.1
Extranodal
Yes	1078	12.9	17.3	15.1	15.7	15.0	15.6	14.5	8.0
No	6088	87.1	82.7	84.9	84.3	85.0	84.4	85.5	92.0
NA	0	0	0	0	0	0	0	0	0
aaIPI
0	1764	36.6	30.3	31.6	25.4	23.0	24.9	21.7	26.3
1	2211	22.8	38.0	31.8	32.9	29.8	28.6	32.3	38.3
2	2199	34.7	25.5	26.2	31.6	34.4	30.5	28.9	21.7
3	945	5.9	6.2	10.2	10.1	12.5	15.5	15.4	10.9
NA	46	0	0	0.2	0	0.3	0.5	1.7	2.8
IPI
0	487	35.6	28.8	29.9	23.9	0	0	0	0
1	1777	20.8	35.6	31.3	30.5	25.0	24.0	20.9	25.1
2	1967	29.7	20.2	21.8	29.3	27.5	25.9	29.9	36.0
3	1703	10.9	12.5	11.4	11.8	28.4	27.9	26.3	24.0
4	945	3.0	2.9	5.4	4.5	14.6	17.0	16.7	9.7
5	240	0	0	0	0	4.2	4.7	4.5	2.3
NA	46	0	0	0.2	0	0.3	0.5	1.7	2.9
R-CHOP/CHOEP
Yes	2343	50.5	47.6	45.3	41.9	37.3	30.0	21.1	6.3
No	536	11.9	15.4	11.1	13.8	7.2	4.3	6.3	2.9
NA	4286	37.6	37.0	43.6	44.3	55.5	65.7	72.6	90.8

aaIPI, age adjusted IPI; DLBCL, diffuse large B-cell lymphoma; ECOG PS, Eastern Cooperative Oncology Group performance status; Extranodal, involvement of 2 or more extranodal sites; IPI, International Prognostic Index; NA, not available; R-CHOEP, R-CHOP and etoposide; R-CHOP, rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone; S-LDH, serum lactate dehydrogenase; Stage, Ann Arbor stage; y, year.

The median survival time for age groups below 60 years of age was never reached during the follow-up period.

Figure 1. (A) Overall and (B) relative survival of DLBCL in Sweden diagnosed 2000–2013, divided into 10-year age groups.

Figure 2. (A) Overall survival of DLBCL in Sweden divided by year of diagnosis. Rituximab was introduced mainly 2003–2005 and from 2006 rituximab was included in national treatment recommendations. (B) Overall survival of DLBCL in Sweden 2006–2013, divided into 10-year age groups.

Figure 3. (A) Overall survival of DLBCL in Sweden 2000–2013 for different aaIPI groups. (B) Overall survival of DLBCL in Sweden 2006–2013 for different aaIPI groups.

Table II. Relative risk ratio (RR) of DLBCL mortality in Sweden 2000–2013.

DLBCL (n = 7165)	RR	95% CI	p
Age (y)
20–29	REF
30–39	1.44	0.60–2.27	0.39
40–49	2.71	1.96–3.46	0.009
50–59	2.52	1.79–3.25	0.014
60–69	3.38	2.65–4.11	< 0.001
70–79	4.59	3.87–5.32	< 0.001
80–89	7.58	6.85–8.30	< 0.001
90–99	2 × 10^–12	–	–
Stage
I	REF
II	1.03	0.85–1.22	0.73
III	1.11	0.92–1.30	0.28
IV	1.37	1.19–1.54	< 0.001
S-LDH
Normal	REF
High	1.76	1.63–1.89	< 0.001
ECOG PS
0	REF
1	2.55	2.39–2.72	< 0.001
2	4.54	4.35–4.72	< 0.001
3	7.13	6.94–7.32	< 0.001
4	12.66	12.45–12.87	< 0.001
Extranodal
No	REF
Yes	1.08	0.96–1.21	0.22

CI, confidence interval; DLBCL, diffuse large B-cell lymphoma; ECOG PS, Eastern Cooperative Oncology Group performance status; Extranodal, involvement of 2 or more extranodal sites; REF, Reference category; RR, Relative risk ratio; S-LDH, serum lactate dehydrogenase; Stage, Ann Arbor stage; y, year.