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. 2018 Apr 9;20(5):687-694.
doi: 10.1093/neuonc/nox187.

The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades

Joe S Mendez  1 , Quinn T Ostrom  2   3 , Haley Gittleman  2   3 , Carol Kruchko  3 , Lisa M DeAngelis  1   4 , Jill S Barnholtz-Sloan  2   3 , Christian Grommes  1   4
Affiliations

The elderly left behind-changes in survival trends of primary central nervous system lymphoma over the past 4 decades

Joe S Mendez et al. Neuro Oncol. .

Abstract

Background: There has been significant improvement in treatment outcomes of primary central nervous system lymphoma (PCNSL) at specialized centers over the past several decades; however, it is unclear if these changes have translated to benefits in the general population.

Methods: In this study, we utilized 2 national databases to examine survival trends over time for PCNSL: the Central Brain Tumor Registry of the United States (CBTRUS, 2000-2013) and 18 registries from the Surveillance, Epidemiology, and End Results program (SEER, 1973-2013).

Results: The annual incidence of PCNSL in 2013 was 0.4 per 100000 population (CBTRUS/SEER). Incidence increased from 0.1 per 100000 in the 1970s to 0.4 per 100000 in the 1980s, correlating with an increase in the diagnosis of patients ≥70 years (1973: 0.2 vs 2013: 2.1 [SEER]). Incidence rates differed greatly between young and elderly patients (age 20-29 y: 0.08 vs 70-79 y: 4.32 [CBTRUS]). Even though the median overall survival of all patients doubled from 12.5 months in the 1970s to 26 months in the 2010s, this survival benefit was limited to patients <70 years. Survival in the elderly population has not changed in the last 40 years (6 mo in the 1970s vs 7 mo in the 2010s, P = 0.1).

Conclusion: The poor outcome seen in the particularly vulnerable elderly patient population highlights the need for clinical trials targeting the elderly in hopes of improving treatment strategies and survival.

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Figures

Fig. 1
Fig. 1
Incidence rates of PCNSL. (A) Incidence rates derived from the SEER registries between 1973 and 2013 and (B) CBTRUS database 2000–2013. (C) Heatmap plot of the incidence rates of PCNSL (SEER) based on patient age and year of diagnosis. (D) Change in incidence rates of PCNSL based on age groups between 2000 and 2013 (CBTRUS). (E) Incidence rates of PCNSL in non-HIV patients (gray, HIV−) and all PCNSL including HIV patients (black, HIV+) (SEER). (F) Heatmap plot of the incidence rates of PCNSL including HIV patients (SEER) based on patient age and year of diagnosis.
Fig. 2
Fig. 2
Distribution of PCNSL by site in the CNS. (A) The distribution of PCNSL within the central nervous system as well as (B) the anatomic site within the brain.
Fig. 3
Fig. 3
Clinical outcome of PCNSL. Kaplan–Meier curves demonstrating clinical outcome in PCNSL (SEER registries 1973–2013). Overall survival of (A) all PCNSL patients, based on (B) gender, (C) age at diagnosis grouped by age <50, 50–69, and ≥70, and (D) decade of diagnosis.
See this image and copyright information in PMC

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