Influence of morphology on survival for non-Hodgkin lymphoma in Europe and the United States

doi:10.1016/j.ejca.2007.12.016

European Journal of Cancer

Volume 44, Issue 4, March 2008, Pages 579-587

https://doi.org/10.1016/j.ejca.2007.12.016 Get rights and content

Abstract

We explored the influence of morphology on geographic differences in 5-year survival for non-Hodgkin lymphoma (NHL) diagnosed in 1990–1994 and followed for 5 years: 16,955 cases from 27 EUROCARE-3 cancer registries, and 22,713 cases from 9 US SEER registries.

Overall 5-year relative survival was 56.1% in EUROCARE west, 47.1% in EUROCARE east and 56.3% in SEER. Relative excess risk (RER) of death was 1.05 (95% confidence interval (CI) 1.01–1.10) in EUROCARE west, 1.52 (95% CI 1.44–1.60) in EUROCARE east (SEER reference). Excess risk of death was significantly above reference (diffuse B lymphoma) for Burkitt’s and NOS lymphoma; not different for lymphoblastic and other T-cell; significantly below reference (in the order of decreasing relative excess risk) for NHL NOS, mantle cell/centrocytic, lymphoplasmacytic, follicular, small lymphocytic/chronic lymphocytic leukaemia, other specified NHL and cutaneous morphologies.

Interpretation of marked variation in survival with morphology is complicated by classification inconsistencies. The completeness and standardisation of cancer registry morphology data needs to be improved.

Introduction

Non-Hodgkin lymphomas (NHL) are a heterogeneous group of lymphoid cancers. Various classifications have been used in recent years, based on morphological and clinical features.1, 2, 3 The recent World Health Organization (WHO) classification uses morphological, genetic immunohistochemical and clinical characteristics to classify NHL according to cell lineage of origin.⁴ The evolving classification for NHL complicates comparisons of disease incidence and survival over time and across regions.⁵

For incidence and survival estimates, population-based cancer registries, particularly in Europe,6, 7 have considered NHL as a single disease entity, although some have taken account of morphology.⁸ US population-based studies have considered distinct morphological groups, exploiting the morphological information available in the Surveillance, Epidemiology and End Results (SEER) database.⁹

The aims of the present study were (a) to test the feasibility of using the information on NHL morphology available in the EUROCARE dataset to evaluate the influence of NHL morphology on prognosis and (b) to compare survival for distinct morphologic subtypes across European countries and between Europe and the US.

Section snippets

Materials and methods

We analysed 16,955 NHL cases diagnosed in 1990–1994 in 27 of the 67 population-based cancer registries participating in EUROCARE-3,¹⁰ and 22,713 NHL cases diagnosed over the same period in 9 US cancer registries (San Francisco-Oakland SMSA, Connecticut, Detroit-Metropolitan, Hawaii, Iowa, New Mexico, Seattle (Puget Sound), Utah and Atlanta-Metropolitan) available in the SEER public use database.¹¹ These datasets included 7982 cases (3785 in EUROCARE and 4197 in SEER) of chronic lymphocytic

Results

Table 1 shows the total number of US cases, and the total number of European cases by registry and geographic area, with quality indicators as percentages: lost to follow-up, discovered at autopsy/DCO, microscopically confirmed and NOS (NHL or lymphoma). Lost to follow-up cases were 0.7% (range 0.0–4.1%) in EUROCARE west, 0.3% (range 0.0–0.8%) in EUROCARE east, 0.6% in EUROCARE overall and 0.0% in SEER. Autopsy/DCO cases were 2.0% (range 0.0–5.9%) in EUROCARE west, 6.9% (range 1.8–10.5%) in

Discussion

We found that the survival of NHL patients diagnosed in 1990–1994 in EUROCARE west was similar to that in SEER patients, and higher than that in EUROCARE east. In the multivariable analysis adjusted by age and sex, differences in overall death risk between the three geographic areas were modest, but became more pronounced after adjustment for morphology, suggesting that not adjusting for morphology results in underestimation of differences. We found similar geographic variations in survival in

Research support

This study was supported by the foundation Compagnia di San Paolo, Turin, Italy and the HAEMACARE project funded by the European Commission.

Conflict of interest statement

None declared.

Acknowledgements

The authors thank Don Ward for helping with the English, Dr. Charles Stiller for critical comments on an earlier version of the manuscript and Chiara Margutti and Samba Sowe for secretarial assistance.

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We undertook a large Surveillance Epidemiology and End Results (SEER) based analysis to describe outcome disparities in different subgroups of aggressive T-cell and B-cell NHL patients, with a focus on various ethnicities.
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^k: The EUROCARE-3 Working Group is: Austria: W. Oberaigner (Tyrol Cancer Registry); Denmark: H.H. Storm (Danish Cancer Society, Department of Cancer Prevention and Documentation); Estonia: T. Aareleid (Estonian Cancer Registry); Czech Republic: M. Jechova, M. Rousarova (IHIS and West Bohemia Cancer Registry); Finland: T. Hakulinen (Finnish Cancer Registry); France: G. Hédelin (Bas-Rhin Cancer Registry), I. Tron, E. Le Gall (Bretagne Childhood Cancer Registry), G. Launoy (Calvados Digestive Cancer Registry), J. Macé-Lesec’h (Calvados General Cancer Registry), J. Faivre (Côte d’Or Digestive Cancer Registry), G. Chaplain (Côte d’Or Gynaecologic Cancer Registry), P.-M. Carli (Côte d’Or Malignant Haemopathies Registry), A. Danzon (Doubs Cancer Registry), B. Tretarre (Hérault Cancer Registry), M. Colonna (Isère Cancer Registry), B. Lacour (Lorraine Childhood Cancer Registry), N. Raverdy (Somme Cancer Registry), C. Berger, F. Freycon (Rhône-Alpes Childhood Registry), P. Grosclaude (Tarn Cancer Registry), J. Estève (University of Lyon); Germany: P. Kaatsch (German Childhood Cancer Registry), H. Ziegler (Saarland Cancer Registry), D. Hölzel, G. Schubert Fritschle (Munich Cancer Registry); Iceland: L. Tryggvadottir (Icelandic Cancer Registry); Italy: F. Berrino (Project Leader), C. Allemani, P. Baili, L. Ciccolallo, P. Crosignani, G. Gatta, A. Micheli, M. Sant, (Fondazione IRCCS ‘Istituto Nazionale dei Tumori’, Milan, Unit of Etiological Epidemiology and Prevention and Lombardy Cancer Registry, Varese Province) S. Ferretti (Ferrara Cancer Registry), E. Conti^l, V. Ramazzotti (Istituto Nazionale Tumori ‘Regina Elena’, Rome, Latina Cancer Registry), M. Vercelli, A. Quaglia (Liguria Region Cancer Registry, DOBIG University GE, IST Genova), F. Pannelli (Macerata Cancer Registry, Marche Childhood Cancer Registry), M. Federico, M.E. Artioli (Modena Cancer Registry), M. Ponz De Leon, P. Benatti (Modena Colorectal Cancer Registry), V. De Lisi, L. Servente (Parma Cancer Registry), R. Zanetti, S. Patriarca (Piedmont Cancer Registry), C. Magnani, G. Pastore (Piedmont Childhood Cancer Registry), L. Gafà, R. Tumino (Ragusa Cancer Registry), F. Falcini (Romagna Cancer Registry), M. Budroni (Sassari Cancer Registry), E. Paci, E. Crocetti (Tuscan Cancer Registry), P. Zambon, S. Guzzinati (Venetian Cancer Registry), R. Capocaccia, E. Carrani, R. De Angelis, P. Roazzi, M. Santaquilani, A. Tavilla, F. Valente, A. Verdecchia (Istituto Superiore di Sanità, Rome); Malta: M. Dalmas (Malta National Cancer Registry); Norway: F. Langmark, A. Andersen (Cancer Registry of Norway, Institute of Population-based Cancer Research); Poland: J. Rachtan (Cracow Cancer Registry), M. Bielska-Lasota, Z. Wronkowski (Warsaw Cancer Registry); Slovakia: I Pleško, A Obsitníková (National Cancer Registry of Slovakia); Slovenia: V. Pompe-Kirn (Cancer Registry of Slovenia); Spain: I. Izarzugaza (Basque Country Cancer Registry), C. Martinez-Garcia (Granada Cancer Registry), I. Garau (Mallorca Cancer Registry), C. Navarro, M.D. Chirlaque (Murcia Cancer Registry), E. Ardanaz, C. Moreno (Navarra Cancer Registry), J. Galceran (Tarragona Cancer Registry), A. Torrella (Childhood Tumor Registry of Valencia), R. Peris-Bonet (National Childhood Cancer Registry and Instituto Lopez Pinero, Valencia); Sweden: L. Barlow, T. Möller (Cancer Registry of Sweden); Switzerland: G. Jundt (Basel Cancer Registry), J.M. Lutz, M. Usel (Geneva Cancer Registry); The Netherlands: J.W.W. Coebergh (Eindhoven Cancer Registry), A. van der Does-van den Berg (Dutch Childhood Oncology Group), O. Visser (Amsterdam Cancer Registry); UK, England: S. Godward (East Anglian Cancer Registry), M.P. Coleman (London School of Hygiene and Tropical Medicine), E.M.I. Williams (Merseyside and Cheshire Cancer Registry), D. Forman (Northern and Yorkshire Cancer Registry and Information Service), M.J. Quinn (Office for National Statistics), M. Roche, S. Edwards (Oxford Cancer Intelligence Unit), C. Stiller (Childhood Cancer Research Group, Oxford), J. Verne (South West Cancer Intelligence Services), H. Møller, J. Bell (Thames Cancer Registry), J.L. Botha (Trent Cancer Registry), G. Lawrence (West Midlands Cancer Intelligence Unit); UK, Scotland: R. Black (Scottish Cancer Intelligence Unit); UK, Wales: J.A. Steward (Welsh Cancer Intelligence and Surveillance Unit).^lDr. Ettore Conti died on August 2, 2003.

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Influence of morphology on survival for non-Hodgkin lymphoma in Europe and the United States

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Research support

Conflict of interest statement

Acknowledgements

Blood

Eur J Cancer

Eur J Cancer

Blood

Eur J Cancer

Blood

Eur J Cancer

Eur J Cancer

Ann Oncol

Eur J Cancer

Lancet

National Cancer Institute sponsored study of classifications of non-Hodgkin’s lymphomas: summary and description of a working formulation for clinical usage

Cancer

A clinical evaluation of the International Lymphoma Study Group classification of non-Hodgkin’s lymphoma

Blood

Changes in cancer registry coding for lymphoma subtypes: reliability over time and relevance for surveillance and study

Cancer Epidemiol Biomarkers Prev

EUROCARE-3: survival of cancer patients diagnosed 1990–94 – results and commentary

Ann Oncol