Actual prognosis during follow-up of survivors of B-cell non-Hodgkin lymphoma in the Netherlands

Abstract

Survival rates determined at diagnosis are often too negative for cancer survivors. Conditional relative survival reflects actual prognosis during follow-up better. Data from all 54,015 patients newly diagnosed in the Netherlands with B-cell non-Hodgkin lymphoma during 1989-2008, aged 15-89 years (Netherlands Cancer Registry), were used. Five-year conditional relative survival was computed for every additional year of survival up to 16 years after diagnosis, according to entity, grade, gender, age, and Ann Arbor stage. The prognosis for survivors of indolent B-cell non-Hodgkin lymphoma improved slightly with each additional year survived up to 91%. For patients with aggressive non-Hodgkin lymphoma conditional relative survival improved strongly during the first year after diagnosis (from 48% to 68%) and gradually thereafter to 93% after 16 years. There were differences between morphological entities. Initial differences in conditional relative survival at diagnosis between groups with different disease stages became smaller with increasing number of years survived. Age remained a prognostic indicator, also after prolonged follow-up. These results help caregivers to plan optimal surveillance and inform patients about their actual prognosis during follow-up. Long-lasting excess mortality among patients with B-cell non-Hodgkin lymphoma indicates the need for additional care long after their diagnosis.

Figure 1.

Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with B-cell non-Hodgkin lymphoma, according to entity.

Figure 2.

(A) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with chronic lymphocytic leukemia, according to age group. (B) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with marginal zone lymphoma, according to age group. (C) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with follicular lymphoma, according to age group. (D) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with diffuse large B-cell lymphoma, according to age group.

Figure 3.

(A) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with follicular lymphoma, according to Ann Arbor stage. (B) Conditional 5-year relative survival for every additional year survived after initial diagnosis of patients with diffuse large B-cell lymphoma (including central nervous system, cutaneous, mediastinal), according to Ann Arbor stage.

Figure 4.

Conditional 3-year relative survival for every additional year survived after initial diagnosis of patients with NHL according to grade and period of diagnosis.