Exploring Demographic, Prognostic, and Socioeconomic Determinants of Survival in Lymphocyte-rich Classical Hodgkin Lymphoma: A National Cancer Database Study.
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BACKGROUND/AIM: Lymphocyte-rich classical Hodgkin lymphoma (LR-cHL) is a rare subtype of Hodgkin lymphoma characterized by a marked absence of neutrophils and eosinophils in its T-cell microenvironment. This study utilized the National Cancer Database (NCDB) to analyze the prognostic, socioeconomic, and demographic factors affecting overall survival (OS) in patients with LR-cHL. PATIENTS AND METHODS: We analyzed 2,987 LR-cHL cases diagnosed from 2004-2020. Survival outcomes were assessed using Kaplan-Meier estimates and multivariate Cox proportional hazards models. Variables included age, sex, race, insurance status, Charlson-Deyo (CD) score, tumor stage, and treatment modalities. RESULTS: OS was significantly impacted by age, sex, comorbidities, stage, and treatment. Every 5-year increase in age raised mortality risk by 27% (HR=1.3; p<0.001), while females had a 27% lower risk than males (HR=0.7; p<0.001). CD score ≥3 increased mortality by 79% (HR=1.8; p=0.006), and stage IV disease doubled the risk compared to stage I (HR=2.1; p<0.001). Medicaid recipients had a 57% higher mortality than privately insured patients (HR=1.6; p=0.006), while uninsured patients paradoxically had lower mortality (HR=0.4; p<0.001). Treatment with primary radiation (HR=0.6), primary chemotherapy (HR=0.7), and adjuvant chemotherapy (HR=0.8) was associated with improved survival (all p<0.05). Race, income, and education were not significant predictors. CONCLUSION: This large-scale analysis confirms that age, sex, comorbidities, stage, and treatment type are key determinants of survival in LR-cHL. Insurance status emerged as a significant socioeconomic factor, with Medicaid coverage linked to worse outcomes and uninsured status unexpectedly associated with better survival, warranting further study. These findings highlight the importance of equitable access to standard therapies and suggest areas for future research into healthcare disparities in LR-cHL.