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

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.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.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.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.