The Elderly Left Behind – Changes in Survival Trends of Primary Central Nervous System Lymphoma Over The Past Four Decades

Abstract

Background

There has been significant improvement in treatment outcomes of Primary Central Nervous System Lymphoma (PCNSL) at specialized centers over the past several decades; however, it is unclear if these changes have translated to benefits in the general population.

Methods

In this study, we utilized two national databases to examine survival trends over time for PCNSL (Central Brain Tumor Registry of the United States (CBTRUS, 2000 – 2013) and 18 Surveillance, Epidemiology, and End Results (SEER, 1973 – 2013) registries).

Results

The annual incidence of PCNSL in 2013 was 0.4 per 100,000 population (CBTRUS/SEER). Incidence increased from 0.1 per 100,000 in the 1970s to 0.4 per 100,000 in the 1980s, correlating with an increase in the diagnosis of patients ≥70 years (1973:0.2 vs 2013:2.1 – SEER). Incidence rates differed greatly between young and elderly patients (age 20–29 years: 0.08 vs 70–79: 4.32 – CBTRUS). Even though the median overall survival of all patients doubled from 12.5 months in the 1970s to 26 in the 2010s, this survival benefit was limited to patients age <70. Survival in the elderly population did not change in the last 40 years (6 months in the 1970s vs 7 in the 2010s, p-value = 0.1).

Conclusion

The poor outcome seen in the particularly vulnerable elderly patient population highlights the need for clinical trials targeting the elderly in hopes of improving treatment strategies and survival.