Management trends and outcomes for stage I-II mantle cell lymphoma using the National Cancer Data Base (NCDB): Ascertaining the ideal treatment paradigm
Menée à partir des données du registre national américain des cancers portant sur 2 539 patients atteints d'un lymphome à cellules du manteau de stade I-II diagnostiqué entre 1998 et 2012 (durée médiane de suivi : 42,8 mois), cette étude analyse l'évolution de l'utilisation de la chimiothérapie et/ou de la radiothérapie, puis évalue, du point de vue de la survie, l'efficacité de différentes stratégies thérapeutiques
Résumé en anglais
Purpose/objective(s) : Mantle cell lymphoma (MCL) is a rare albeit aggressive subset of non-Hodgkin’s lymphoma, resulting in varied treatment approaches. Given the paucity of data defining optimal management for early stage MCL, we conducted an analysis using the National Cancer Data Base (NCDB) to identify practice patterns and outcomes.
Methods and materials : The NCDB was queried for patients with stage I-II MCL diagnosed from 1998-2012 receiving chemotherapy (CT), radiotherapy (RT) or both (CT+RT). Univariate and multivariable analysis for factors associated with treatment selection was completed using logistic regression. Propensity scores with inverse probability treatment weighting (IPTW) were calculated based on the conditional probability of receiving CT+RT. Log-rank test and Cox proportional hazards modeling with IPTW-adjustment were conducted for survival analyses.
Results : In total, 2,539 patients were identified. Key characteristics were as follows: 69% male, 71% age ≥60, 28% extranodal involvement and 51% stage I. Patients were treated with CT (70%), RT (11%) or CT+RT (19%). Utilization of CT+RT decreased from 23.1 to 14.1% in 1998-2002 and 2010-2012 (p<0.001). CT+RT utilization was lower for patients with the following characteristics: ≥60 years old, female, stage II, or with B symptoms. With a median follow-up of 42.8 months, the unadjusted 3-year overall survival estimates for patients receiving CT, RT, or CT+RT were 67.8, 72.4, and 79.8%, respectively (p<0.001). After correcting for indication bias through IPTW-adjusted modeling, CT+RT reduced the risk of overall mortality compared to monotherapy (HR 0.65, p=0.029).
Conclusions : Although uncommon, patients with stage I-II MCL have favorable outcomes. Despite a continued decline in the utilization of consolidative radiotherapy, combined modality therapy improves survival in this cohort compared to monotherapy.
