National Trend in Splenectomy for Splenic Marginal Zone Lymphoma (SMZL): An Analysis of Surveillance, Epidemiology and End Results (SEER) Database
Notice bibliographique
Résumé
Abstract Introduction: In the modern era, Rituximab (R) has been demonstrated to be a very effective therapy for patients with SMZL. Although there are no randomized controlled trials, historical data have demonstrated good outcomes with R alone, allowing patients to forego splenectomy as a treatment modality. Most recently however, a retrospective study from Vancouver showed superior outcomes with splenectomy as compared to chemotherapy in the front line setting. We aimed to determine the national trend in splenectomy rate for SMZL using a US population-based database. Methods: We utilized the SEER 18 database to identify all patients with SMZL between the years 1998-2012 using International Classifications of Disease for Oncology, 3rd edition (ICD-O-3) code 9689/3. Only cases with known age, race, stage, receipt of surgery and follow up information were included. Median Overall survival (OS) and 5-year OS were calculated using Kaplan Meier method. Using Poisson regression methods, we estimated the yearly splenectomy rate adjusting for age, gender and stage at diagnosis. Estimated annual percentage change (EAPC) was calculated as the antilog for the regression coefficient for year minus 1 times 100 [i.e. EAPC = {exp(year of diagnosis) -1} x 100].Flexible but smooth rate was obtained with restricted cubic splines using Akaike's information criteria. All p-values were two-sided and the level of significance was chosen at 0.05. Results: A total of 1368 patients with SMZL met eligibility criteria. The median age was 69 years (range 25-96 years). The study population comprised of 53% females(n=721) and 90% whites (n=1236). A total of 70% (n=951) were stage IV at diagnosis. A total of 40% (n=540) received splenectomy, whereas only 16 patients (1.2%) received radiation therapy. The receipt of chemotherapy could not be analyzed. The adjusted rate in splenectomy declined sharply from 79.5% in 1998 to 24.7% in 2012 at an EAPC of -5.34 (95% CI -7.56 to -3.07; p<0.01). Figure 1 shows the restricted cubic spline graph showing a decline in adjusted splenectomy rate during the study time period. The median and 5-year OS was 101 months and 66% respectively. Conclusion: Our population-based study demonstratesa steady decline in the rate of splenectomy for SMZL between 1998-2012. This declining rate is likely reflective of increasing use of R or R based chemotherapy regimens for the treatment of patients with SMZL. It also likely reflects to some extent improved pathologic characterization of this entity based on bone marrow evaluation alone, decreasing the need for a diagnostic splenectomy. Figure 1. Restricted cubic spline graph showing the declining trend in splenectomy rate among patients with SMZL. The rate was adjusted for age, gender and stage at diagnosis. Figure 1. Restricted cubic spline graph showing the declining trend in splenectomy rate among patients with SMZL. The rate was adjusted for age, gender and stage at diagnosis. Disclosures Armitage: Ziopharm: Consultancy; Conatus: Consultancy, Membership on an entity's Board of Directors or advisory committees; Tesaro Bio, Inc: Membership on an entity's Board of Directors or advisory committees; Spectrum: Consultancy; Roche: Consultancy; Celgene: Consultancy; GlaxoSmithKline: Consultancy, Membership on an entity's Board of Directors or advisory committees.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,005 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».