All-cause and tumor-specific mortality trends in elderly primary central nervous system lymphoma (PCNSL) patients: a surveillance, epidemiology, and end results (SEER) analysis.

BACKGROUND

Recent primary central nervous system lymphoma (PCNSL) literature indicates that younger patients benefit from improved survival, however, this benefit is not shared by those 70+ years of age. The purpose of this study is to examine mortality trends in PCNSL patients 70+ years of age to better understand why improved prognosis has not yet reached this rapidly growing population subset.

METHODS

2075 cases (1973-2012, age at diagnosis 70+ years) within the Surveillance, Epidemiology, and End Results (SEER) database were included in Kaplan-Meier and multivariate Cox Regression analyses. Variables include age at diagnosis, decade of diagnosis (1=1973-1982, 2=1983-1992, 3=1993-2002, 4=2003-2012), sex, race and surgery.

RESULTS

Before stratification, both univariate and multivariate analyses agreed that patients aged 70-74 years at diagnosis lived the longest, while those 85+ years lived the shortest (median±SD; 6.0±0.5 months vs 2.0±0.2 months, respectively, p<0.0005); women lived longer than men (5.0±0.3 months vs 4.0±0.3 months, respectively, p=0.01); patients who received surgery (6.0±0.5 months) lived longer than those who did not (contraindicated = 1.0±0.5 months, p<0.0005; not performed = 4.0±0.3 months, p<0.0005). Univariate analysis showed decade 4 lived longer than only decade 3 (4.0±0.3 vs 4.0±0.5, respectively, p=0.008), while multivariate analysis showed decade 4 lived longer than both 2 (5.0±0.8 months, p=0.03) and 3 (p<0.0005). Following stratification, decade and sex no longer influenced survival. Race did not influence survival.

CONCLUSIONS

Minimal clinically meaningful improvements in elderly PCNSL patient all-cause and tumor-specific mortality have been made since 1973, while the best predictors of longevity include younger age and surgery.