Age-related differences in primary central nervous system lymphomas based on the SEER database

Abstract

Abstract Objective: The aim of this study was to compare prognostic factors and survival outcomes in patients with primary central nervous system lymphoma (PCNSL) stratified according to age (younger vs older than 60 years of age). Methods: The Surveillance, Epidemiology, and End Results (SEER) database was queried for all patients diagnosed with PCNSL between 2000 and 2019. Clinical parameters were collected, and patients were stratified and compared according to age. Results: Between 2000 and 2019, a total of 5812 patients were diagnosed with PCNSL, of whom 2175 (37%) were ≤ 60 years old and 3637 (63%) were > 60 years old, hereafter referred to as “younger” and “older” patients, respectively. The younger patients had a higher rate of being diagnosed with stage I–II PCNSL (64% vs 60%), a higher rate of receiving chemotherapy (68% vs 63%), a higher rate of receiving radiotherapy (34% vs 26%, P < 0.001), a similar rate of receiving surgery, and a longer survival time. The most common histological subtype among PCNSL patients was diffuse large B-cell lymphoma (DLBCL) (PCNS-DLBCL; n = 4458, 77%). Multifactorial Cox regression analysis showed that younger PCNS-DLBCL patients who received surgery and chemotherapy exhibited significantly improved overall survival (OS) and disease-specific mortality (DSM) and that African American patients were associated with poorer OS and DSM. Older patients receiving surgery, chemotherapy, and radiotherapy exhibited significantly improved OS and DSM, and male sex and higher Ann Arbor stage were associated with poorer OS and DSM. We created a nomogram for PCNS-DLBCL to predict OS, with a C-index of 0.6749 (95% confidence interval: 0.6641–0.6857) in the younger cohort and 0.6676 (95% confidence interval: 0.6595–0.6759) in the older cohort, indicating that the nomogram had good predictive value. In the combined therapy analysis, chemotherapy combined with surgical resection had better OS and DSM in all patients. Conclusions: The two age-stratified cohorts significantly differed in terms of OS and independent influences on OS and DSM. However, chemotherapy combined with surgical resection resulted in better OS and DSM in all patients. Our constructed nomogram exhibited high accuracy in predicting OS in PCNS-DLBCL patients.