Impact of socioeconomic individual and ecological factors on extreme diagnosis-to-treatment interval in diffuse large B-Cell lymphoma in the French real-world cohort REALYSA

IF 2.3 3区医学 Q3 ONCOLOGY

Cancer Epidemiology Pub Date : 2025-08-14 DOI:10.1016/j.canep.2025.102875

Christelle Cantrelle , Aurélien Belot , Alain Monnereau , Fontanet Bijou , Cédric Rossi , Côme Bommier , Hadia Khebbeb Hafirassou , Ludovic Fouillet , Hervé Ghesquières , Loic Ysebaert , Sandra Le Guyader Peyrou

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Abstract

Introduction

Diffuse large B-cell lymphoma (DLBCL) is an aggressive though potentially curable lymphoid malignancy requiring timely treatment initiation. We investigated the impact of individual socioeconomic status and home area-level (ecological) factors on the diagnosis-to-treatment interval (DTI) in DLBCL patients, focusing on extreme delays in a French real-world cohort (REALYSA).

Methods

We analyzed patients with newly diagnosed DLBCL in the multicentric prospective cohort. DTI was defined as a duration in days between diagnosis confirmation and first-line therapy. Short and long DTIs (10th percentiles) were compared to intermediate DTI using multinomial models to identify factors associated with extreme DTIs. Socio-demographic data (including sex, education, employment, marital status, social support (SSQ6-score)…) and ecological characteristics (French deprivation index, local accessibility to general practitioners) were considered.

Results

Among 889 newly diagnosed DLBCL patients (median age 66 years, 49 % with aaIPI ≥1, 35 % with B-symptoms, 33 % with bulky disease), median DTI was 25 days (interquartile range: 15–39 days). The 10th- and 90th-percentile for extreme DTIs were < 8 and > 50 days respectively. In multivariable analysis, factors associated with short DTI included aaIPI (OR=3.03, CI95 %[1.44–6.41]), bulky disease (OR=3.06, CI95 %[1.68–5.58]), and B symptoms (OR=2.35, CI95 %[1.30–4.25]) - indicating expedited treatment for aggressive presentations. Conversely, factors associated with long DTI included older age (OR>80 y = 3.31, CI95 %[1.39–7.89]), being a blue-collar worker or farmer (OR=2.36, CI95 %[1.18–4.73]), or changing type of treatment facility between biopsy and initial treatment.

Conclusion

In this large real-world cohort of newly diagnosed DLBCL patients, age, occupational status, and patients’ pathway were linked to very long delays to treatment. Interventions to streamline DTIs, especially for older and/or blue-collar or farmer patients, and for those changing facility of treatment, are warranted to improve quality of care.

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社会经济个体和生态因素对弥漫性大b细胞淋巴瘤极端诊断至治疗间隔的影响

弥漫性大b细胞淋巴瘤（DLBCL）是一种侵袭性的但有可能治愈的淋巴细胞恶性肿瘤，需要及时治疗。我们调查了个体社会经济地位和家庭区域水平（生态）因素对DLBCL患者诊断至治疗间隔（DTI）的影响，重点关注法国现实世界队列（REALYSA）的极端延迟。方法采用多中心前瞻性队列分析新诊断的DLBCL患者。DTI定义为从确诊到一线治疗之间的持续时间（以天为单位）。使用多项模型将短DTI和长DTI（第10百分位数）与中间DTI进行比较，以确定与极端DTI相关的因素。考虑了社会人口统计数据（包括性别、教育、就业、婚姻状况、社会支持（SSQ6-score）……）和生态特征（法国剥夺指数、当地全科医生的可及性）。结果在889例新诊断的DLBCL患者中（中位年龄66岁，49 % aaIPI≥1,35 % b症状，33 %大体积疾病），中位DTI为25天（四分位数间距：15-39天）。极端dti的第10百分位和第90百分位分别为<； 8和>； 50天。在多变量分析中，与短DTI相关的因素包括aaIPI （OR=3.03, CI95 %[1.44-6.41]）、大体积疾病（OR=3.06, CI95 %[1.68-5.58]）和B症状（OR=2.35, CI95 %[1.30-4.25]），这表明对侵袭性症状需要加快治疗。相反，与长DTI相关的因素包括年龄较大（or >80 y = 3.31,CI95 %[1.39-7.89]），蓝领工人或农民（or =2.36, CI95 %[1.18-4.73]），或在活检和初始治疗之间改变治疗设备类型。在这个新诊断的DLBCL患者的大型现实队列中，年龄、职业状况和患者的途径与治疗延误时间很长有关。简化dti的干预措施，特别是对老年人和/或蓝领或农民患者，以及那些改变治疗设施的患者，有必要提高护理质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Epidemiology 医学-肿瘤学

CiteScore

4.50

自引率

3.80%

发文量

200

审稿时长

39 days

期刊介绍： Cancer Epidemiology is dedicated to increasing understanding about cancer causes, prevention and control. The scope of the journal embraces all aspects of cancer epidemiology including: • Descriptive epidemiology • Studies of risk factors for disease initiation, development and prognosis • Screening and early detection • Prevention and control • Methodological issues The journal publishes original research articles (full length and short reports), systematic reviews and meta-analyses, editorials, commentaries and letters to the editor commenting on previously published research.