Association of age and primary treatment with risk of non-lymphoma-related death and long-term survival outcomes in adult patients with early-stage follicular lymphoma: a population-based analysis.

Authors

Chang Xu, Yunpeng Wu, Xin Liu, Qiu-Zi Zhong, Yong Yang, Tao Wu, Si-Ye Chen, Bo Chen, Yong-Wen Song, Hui Fang, Jing Jin, Yue-Ping Liu, Hao Jing, Yuan Tang, Ning Li, Ning-Ning Lu, Wen-Wen Zhang, Shu-Lian Wang, Jingru Zhu, Shu-Nan Qi, Ye-Xiong Li

Published in

Annals of hematology. Jun 24, 2026. Epub Jun 24, 2026.

Abstract

In adult patients with early-stage follicular lymphoma (FL), age-related differences in the risk of non-lymphoma-related death (LRD) during the follow-up period after treatment are unclear. We aimed to investigate the interactive effects of age and primary treatment on the risk of non-LRD and survival. We retrospectively analyzed the data of 6030 adult patients with early-stage FL from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Primary therapy involved observation (n = 2509), chemotherapy (CT) alone (n = 1844), radiotherapy alone (RT, n = 1191) or RT and CT (RT + CT, n = 486). The groups were balanced by inverse probability of treatment weighting (IPTW). Comparisons of the cumulative incidence of non-LRD were performed using competing-risk analysis and transformed Cox regression analysis. The median patient age was 64 years (RT, 62 years; RT + CT, 60 years; CT, 63 years; observation, 66 years). Over a median follow-up period of 132 months, 830 patients (13.8%) died of FL, while non-LRD accounted for 1279 patients (21.2%). Age significantly influenced the non-LRD risk, especially in patients aged > 60 years. After IPTW adjustment, RT alone, RT + CT or CT alone was not associated with an increased risk of the cumulative incidences of non-LRD or its specific causes in comparison with observation. Age-dependent analyses showed that the adjusted hazard ratios (HRs) for RT alone, RT + CT or CT versus observation remained close to 1.0 across the age spectrum, indicating no significant difference in non-LRD risk between treatment groups. RT alone and RT + CT conferred sustained overall survival (OS), disease specific survival (DSS) and relative survival (RS) advantages over CT or observation, with RS consistently exceeding 90% over the extended follow-up period. The survival benefit of RT versus non-RT persisted across age groups, with the adjusted HRs for OS and RS remaining below 1.0 for most ages. Older age, not primary treatment, was associated with an increased risk of non-LRD. The results indicated the safety and long-term survival benefit of RT in adult patients with early-stage FL.

PMID:
42340431
Bibliographic data and abstract were imported from PubMed on 24 Jun 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.