Research Paper Volume 11, Issue 19 pp 8463—8473

Effect of age as a continuous variable on survival outcomes and treatment selection in patients with extranodal nasal-type NK/T-cell lymphoma from the China Lymphoma Collaborative Group (CLCG)

Wei-Xin Liu 1, *, , Mei Shi 2, *, , Hang Su 3, , Ying Wang 4, , Xia He 5, , Li-Ming Xu 6, , Zhi-Yong Yuan 6, , Li-Ling Zhang 7, , Gang Wu 7, , Bao-Lin Qu 8, , Li-Ting Qian 9, , Xiao-Rong Hou 10, , Fu-Quan Zhang 10, , Yu-Jing Zhang 11, , Yuan Zhu 12, , Jian-Zhong Cao 13, , Sheng-Min Lan 13, , Jun-Xin Wu 14, , Tao Wu 15, , Su-Yu Zhu 16, , Shu-Nan Qi 1, , Yong Yang 1, , Bo Chen 1, , Ye-Xiong Li 1, ,

  • 1 State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, P. R. China
  • 2 Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
  • 3 307 Hospital, Academy of Military Medical Science, Beijing, P. R. China
  • 4 Chongqing Cancer Hospital and Cancer Institute, Chongqing, P. R. China
  • 5 Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research, Nanjing, P. R. China
  • 6 Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin, P. R. China
  • 7 Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
  • 8 The General Hospital of Chinese People's Liberation Army, Beijing, P. R. China
  • 9 The Affiliated Provincial Hospital of Anhui Medical University, Hefei, P. R. China
  • 10 Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, P. R. China
  • 11 Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China
  • 12 Zhejiang Cancer Hospital, Hangzhou, P. R. China
  • 13 Shanxi Cancer Hospital and the Affiliated Cancer Hospital of Shanxi Medical University, Taiyuan, P. R. China
  • 14 Fujian Provincial Cancer Hospital, Fuzhou, Fujian, P. R. China
  • 15 Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, P. R. China
  • 16 Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, P. R. China
* Equal contribution

received: July 12, 2019 ; accepted: September 22, 2019 ; published: October 6, 2019 ;

https://doi.org/10.18632/aging.102331
How to Cite

Copyright © 2019 Liu et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose: The aim of this study was to determine the impact of analyzing age as a continuous variable on survival outcomes and treatment selection for extranodal nasal-type NK/T-cell lymphoma.

Results: The risk of mortality increased with increasing age, without an apparent cutoff point. Patients’ age, as a continuous variable, was independently associated with overall survival after adjustment for covariates. Older early-stage patients were more likely to receive radiotherapy only whereas young-adult advanced-stage patients tended to receive non-anthracycline-based chemotherapy. A decreased risk of mortality with radiotherapy versus chemotherapy only in early-stage patients (HR, 0.347, P < 0.001) or non-anthracycline-based versus anthracycline-based chemotherapy in early-stage (HR, 0.690, P = 0.001) and advanced-stage patients (HR, 0.678, P = 0.045) was maintained in patients of all ages.

Conclusions: These findings support making treatment decisions based on disease-related risk factors rather than dichotomized chronological age.

Patients and Methods: Data on 2640 patients with extranodal nasal-type NK/T-cell lymphoma from the China Lymphoma Collaborative Group database were analyzed retrospectively. Age as a continuous variable was entered into the Cox regression model using penalized spline analysis to determine the association of age with overall survival (OS) and treatment benefits.

Abbreviations

NKTCL: Extranodal nasal-type NK/T-cell lymphoma; RT: Radiotherapy; CT: Chemotherapy; DLBCL: Diffuse large B-cell lymphoma; CLCG: China Lymphoma Collaborative Group; CMT: Combined modality treatment; ANT: Anthracycline; AIC: Akaike’s information criterion; HR: Hazard ratio; CI: Confidence intervals; PS: Performance status; ECOG: Eastern Cooperative Oncology Group; LDH: Lactate dehydrogenase; PTI: Primary tumor invasion.