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. 2019 Nov 12:9:1198.
doi: 10.3389/fonc.2019.01198. eCollection 2019.

Incidence and Mortality Trends and Risk Prediction Nomogram for Extranodal Diffuse Large B-Cell Lymphoma: An Analysis of the Surveillance, Epidemiology, and End Results Database

Xuejiao Yin  1 , Aoshuang Xu  1 , Fengjuan Fan  1 , Zhenli Huang  1 , Qianwen Cheng  1 , Lu Zhang  1 , Chunyan Sun  1   2 , Yu Hu  1   2
Affiliations

Incidence and Mortality Trends and Risk Prediction Nomogram for Extranodal Diffuse Large B-Cell Lymphoma: An Analysis of the Surveillance, Epidemiology, and End Results Database

Xuejiao Yin et al. Front Oncol. .

Abstract

Background: DLBCL is the most commonly occurring type of non-Hodgkin's lymphoma, which may be found at various extranodal sites. But little is known about the particular trends of extranodal DLBCL. Methods: A total of 15,882 extranodal DLBCL patients were included in incidence analysis from the Surveillance, Epidemiology, and End Results (SEER) database (1973-2015). The joinpoint regression software was used to calculate the annual percent change (APC) in rates. Nomograms were established by R software to predict overall survival (OS). Results: The extranodal DLBCL incidence continued to rise at a rate of 1.6% (95% CI, 0.4-2.8, p < 0.001) per year over the study period, until it declined around 2003. The incidence-based mortality trend of extranodal DLBCL had a similar pattern, with a decrease happening around 1993. Five-year survival rates improved dramatically from the 1970s to 2010s (44.15 vs. 63.7%), and the most obvious increase occurred in DLBCL patients with primary site in the head/neck. The C-index showed a value for OS of 0.708, which validated the nomograms performed well and were able to forecast the prognosis of patients with extranodal DLBCL. The calibration curves showed satisfactory consistency between true values and predicted values for 1-, 5-, and 10-year overall survival, respectively. Conclusions: The incidence and incidence-based mortality of extranodal DLBCL had been increasing for decades, followed by a promising downward trend in recent years. These findings may help scientists identify disease-related risk factors and better manage the disease. The prediction signature cloud identifies high-risk patients who should receive effective therapies to prevent the fatal nature of this disease, and low-risk patients to reduce over-treatment.

Keywords: extranodal DLBCL; incidence; incidence-based mortality; nomograms; prognosis.

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Figures

Figure 1
Figure 1
The overall trends of incidence of extranodal DLBCL.
Figure 2
Figure 2
Trends of annual incidence of extranodal DLBCL according to gender.
Figure 3
Figure 3
Trends of annual incidence of extranodal DLBCL according to stage.
Figure 4
Figure 4
Trends of annual incidence of extranodal DLBCL according to age.
Figure 5
Figure 5
Trends of annual incidence of extranodal DLBCL according to race.
Figure 6
Figure 6
Trends of annual incidence of extranodal DLBCL according to sites.
Figure 7
Figure 7
Kaplan–Meier's analysis for extranodal DLBCL. Graph shows increasing survival from the 1970s to 2010s. (A) Overall survival analysis; (B) Overall survival in Head/Neck; (C) Overall survival in Hematologic system.
Figure 8
Figure 8
Nomograms of patients with extranodal DLBCL for predicting overall survival.
Figure 9
Figure 9
The calibration curves for predictions of overall survival at 1 year after diagnosis.
Figure 10
Figure 10
The calibration curves for predictions of overall survival at 5 years after diagnosis.
Figure 11
Figure 11
The calibration curves for predictions of overall survival at 10 years after diagnosis.
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