Male gender is an adverse risk factor only in young patients with diffuse large B-cell lymphoma – a Swedish population-based study

Figures & data

Figure 1. Survival of DLBCL diagnosed in Sweden 2000–2013. (A) Observed overall survival for all men and women (log rank test p = 0.6). (B) Observed overall survival for young and old men and women (log rank test for young persons p = 0.007 and for old persons p = 0.4). Cut-off for young versus old is 51–52 years (mean age for menopause for women in Sweden). (C) Relative survival for young and old men and women. (D) Relative survival for patients younger than 52 years, middle aged patients aged 52–60 years, and patients older than 60 years.

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

Total	All		p	Age < 52 years		p	Age > 52 years		p
	Men	Women		Men	Women		Men	Women
	3943 (55%)	3223 (45%)		518 (13%)	362 (11%)		3425 (87%)	2861 (89%)
Stage
1	828	686	0.02	139	93	0.3	689	593	0.01
2	893	786		129	109		764	677
3	648	543		88	52		560	491
4	1431	1040		156	103		1275	937
NA	143	168		6	5		137	163
S-LDH
Normal	1548	1185	0.07	229	144	0.2	1319	1041	0.2
High	2160	1811		270	209		1890	1602
NA	235	227		19	9		216	218
ECOG PS
0	1609	1141	0.000018	291	193	0.9	1318	948	0.000045
1	1277	1133		147	112		1130	1020
2	443	358		37	28		406	330
3	333	345		22	14		311	331
4	202	170		13	8		189	162
NA	79	76		8	6		71	70
Extranodal
Yes	617	461	0.1	451	296	0.039	2875	2466	0.01
No	3326	2762		67	66		550	395
aaIPI
0	982	782	0.9	157	112	0.9	825	670	0.8
1	1204	1007		178	120		1026	887
2	1216	983		140	96		1076	887
3	520	425		42	34		478	391
NA	21	26		1	0		20	26
IPI
0	292	195	0.2	154	104	0.8	138	91	0.2
1	990	787		167	115		823	672
2	1059	908		121	81		938	827
3	920	783		56	43		864	740
4	533	412		19	19		514	393
5	128	112		0	0		128	112
NA	21	26		1	0		20	26
NCCN-IPI
Mean age (range)	67 (20–99)	69 (20–105)		41 (20–51)	41 (20–51)		71 (52–99)	73 (52–105)

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; S-LDH, serum lactate dehydrogenase; Stage, Ann Arbor stage.

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

	All DLBCL		p	DLBCL < 52 years		p	DLBCL > 52 years		p
	RR	95% CI		RR	95% CI		RR	95% CI
Sex
Women	REF			REF			REF
Men	1.02	0.92–1.12	0.7	1.51	1.14–1.88	0.03	0.99	0.89–1.10	0.9
Stage
I	REF			REF			REF
II	1.01	0.82–1.20	0.9	0.79	0.15–1.43	0.5	1.02	0.83–1.22	0.8
III	1.09	0.90–1.29	0.4	0.96	0.29–1.63	0.9	1.08	0.87–1.28	0.5
IV	1.34	1.16–1.52	0.001	1.37	0.77–1.97	0.3	1.31	1.13–1.50	0.004
S-LDH
Normal	REF			REF			REF
High	1.60	1.47–1.73	< 0.001	2.02	1.53–2.52	0.005	1.59	1.45–1.72	< 0.001
ECOG PS
0	REF			REF			REF
1	3.09	2.92–3.27	< 0.001	2.52	2.03–3.01	< 0.001	2.97	2.79–3.16	< 0.001
2	5.95	5.75–6.14	< 0.001	3.05	2.39–3.71	0.001	5.77	5.57–5.98	< 0.001
3	9.44	9.24–9.63	< 0.001	9.00	8.38–9.63	< 0.001	8.66	8.46–8.87	< 0.001
4	16.0	15.8–16.2	< 0.001	12.1	11.4–12.8	< 0.001	15.0	14.8–15.3	< 0.001
Extranodal
No	REF			REF			REF
Yes	0.99	0.86–1.12	0.9	0.96	0.48–1.44	0.9	1.03	0.90–1.17	0.6
Sex
Women	REF			REF			REF
Men	1.00	0.90–1.10	0.9	1.47	1.10–1.84	0.04	0.97	0.87–1.07	0.6
Stage
I–II	REF			REF			REF
III–IV	1.40	1.28–1.51	< 0.001	1.39	0.96–1.81	0.1	1.36	1.24–1.48	< 0.001
S-LDH
Normal	REF			REF			REF
High	1.86	1.73–1.99	< 0.001	2.31	1.84–2.78	< 0.001	1.82	1.69–1.96	< 0.001
ECOG PS
0–1	REF			REF			REF
2–4	4.07	3.96–4.18	< 0.001	3.29	2.90–3.67	< 0.001	3.93	3.82–4.04	< 0.001
Extranodal
No	REF			REF			REF
Yes	1.10	0.97–1.22	0.1	1.38	0.96–1.81	0.1	1.11	0.98–1.23	0.1

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.

Figure 2. Relative survival of DLBCL in Sweden diagnosed 2000–2013 according to Ann Arbor stage. (A) All patients grouped according to Ann Arbor stage. (B) Patients younger than 52 years (mean age for menopause for women in Sweden) according to gender and Ann Arbor stage.

Figure 3. (A) Relative survival of all DLBCL patients, and (B) observed overall survival of DLBCL patients younger than 52 years, diagnosed in Sweden 2000–2013. (A) Patients grouped according to normal (Norm) or high serum lactate dehydrogenase (S-LDH) and age. Cut-off for young versus old is 51–52 years (mean age for menopause for women in Sweden). (B) Patients younger than 52 years grouped according to normal (Norm) or high serum lactate dehydrogenase (S-LDH) and gender. Women with normal S-LDH had a significantly longer overall survival compared to the men (log rank test p = 0.03) whereas no difference was found for patients with elevated S-LDH (log rank test p = 0.09).