Survival analysis of lymphoid neoplasms and impact of comorbidity in patients with chronic lymphocytic leukemia in Girona: a population-based study

Comprehensive population-based studies assessing the survival of hematological entities are scarce and typically conducted using old classifications schemes, which hampers their interpretation and international comparisons. Therefore, this thesis is aimed at studying the survival of lymphoid neoplasms (LNs) and its subtypes in the province of Girona, according to the 2008 World Health Organization (WHO) classification. It further provides a sub-analysis focused on estimating the prevalence of comorbidities and their potential impact on survival and mortality (related or not to chronic lymphocytic leukemia (CLL)) of patients diagnosed with CLL. Data were extracted from the Girona Cancer Registry between 1996-2015 for all LNs and observed survival (OS) and relative survival (RS) were calculated using the Kaplan Meier and Pohar Perme methods, respectively. For the CLL sub-analysis, we focused on a more recent period (2008-2016) in order to have access to computerized medical records. Clinical variables were collected at diagnoses and comorbidities were assessed using Charlson Comorbidity Index (CCI). The 5-year RS of the LNs was 62.3% (95% confidence interval (CI): 60.4–64.4) and varied notably according to the different subtypes. The RS of all LNs progressively decreased with advancing patient age, and an increase in RS was observed during 1996-2002 and 2003-2008. In the CLL sub-analysis, survival decreased markedly with increasing CCI scores, but the effect of CCI score disappeared when age and stage are also considered. On the other hand, the CCI score does not play a role predictor of mortality. In conclusion, the LNs survival analysis related possible changes in survival probability to improvements in both diagnostic approach and treatment of the different LNs. Moreover, the high-resolution sub-analysis of CLL cases further allowed us to identify how survival was conditioned by comorbidities at diagnosis ​
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