A Comprehensive Two-Decade Analysis of Lymphoma Incidence Patterns in Saudi Arabia

Abstract

Background: Lymphomas account for approximately 10% of all cancer cases among the Saudi population. Even when separated, Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are in the top ten most commonly diagnosed cancers among Saudi men and women. Despite the substantial cost of HL and NHL to public health, the resources to assess their impact are insufficient. This study provides a two-decade detailed assessment of lymphoma incidence trends in the Saudi population. Methods: Analysis of the Saudi Cancer Registry (SCR) data for various incidence metrics from 2001 to 2020 was conducted. Joinpoint regression analysis was further performed to investigate temporal trends globally and by age group, gender, and administrative region. Results: HL cases grew by 174.1%, whereas NHL cases increased by only 80% for that time period. The HL overall Age-Standardized Incidence Rate (ASR) increased by 100% for both genders combined but remained unchanged for NHL. The median age at diagnosis for HL (20-30 years) and NHL (46-57 years) was lower than in many other nations. Our model identified increasing trends for HL with annual percentage changes (APCs) of 2.94% (CI: 2.2-3.7) and 3.67% (CI: 2.6-4.7) for males and females, respectively. The rise was mainly among young groups under 40. On the contrary, the NHL cohort revealed notable declining tendencies. We discovered alarming rates of HL in Saudi Arabia's APC (2.23% for males and 3.88% for females) and ASR compared to other Western countries. Overall, the majority of the patients presented with advanced-stage disease at a younger age and with slight male predominance. Conclusions: The overall incidence of lymphoma (especially HL) has been rising among Saudis. Implementation of secondary and tertiary prevention measures, as well as management of modifiable risk factors, is warranted.

Keywords: Hodgkin; Saudi Arabia; cancer registry; cancer trends; incidence; lymphoma; non-Hodgkin; patterns.

Figure 1

An annual overview of Saudi Arabia’s cancer cases. The total number of cancer cases for all genders (brown), men (blue), and women (pink) from 2001 to 2020 is displayed on the y-axis.

Figure 2

Lymphoma cases in Saudi Arabia. (A) The number of lymphoma cases (y-axis) among Saudis per year. (B) The portion of cases of lymphoma among all cases of cancer as a percentage (y-axis). (C) The y-axis indicates the median age of lymphoma diagnosis. The years 2001–2020 are depicted on the x-axis of all figures. Males are labeled blue, females pink, and the total is brown. HL = Hodgkin lymphoma; NHL = non-Hodgkin lymphoma.

Figure 3

Lymphoma incidence rates in the Saudi population. (A) The total ASR for lymphoma across the nation for every gender (color-coded). For both genders and each age group (x-axis), AIR values are displayed for HL (B) and NHL (C). (D) Males (blue) and females (pink) boxplot comparisons of AIR for each age group in HL and NHL; ns denotes no significance; * p < 0.05, ** p < 0.01, *** p < 0.001, and **** p < 0.0001. Rates shown on the y-axis are expressed as per 100,000 people.

Figure 4

Trends in lymphoma incidence patterns in Saudi Arabia. (A) Temporal changes in ASR of lymphoma for both genders for HL (A) and NHL (B) between 2001 and 2020. The estimated APC for each prediction model is provided beneath each plot (* indicates p < 0.05). (C) The APC of HL and NHL ASR (2002–2016) for specified nations in comparison to Saudi Arabia. The horizontal line shows the 95% confidence interval (CI), and the central diamond reflects the estimated APC value. (D) A pyramid plot showing the HL and NHL ASR for both genders in Saudi Arabia and multiple nations in 2016.

Figure 5

Distribution of lymphoma stages and subtypes among Saudis. HL and NHL stages (A,B) and subtypes (C,D) distributions are plotted as percentages on the y-axis in stacked area plots. For every gender, the stages and subtypes are color-coded (males = blue shades; females = pink shades). The years 2002–2017 are marked on the x-axis of all figures.