For patients with diffuse large B-cell lymphoma (DLBCL), early diagnosis may be crucial to survival, but the consequences of a longer diagnostic wait time on survival in DLBCL have received little study. A recent study with results published in the British Journal of Haematology found that longer diagnostic wait time was associated with poorer outcomes in some patients with DLBCL.
The study was a single center, retrospective analysis of outcomes in 193 patients with DLBCL who were treated at the University of Fukui Hospital in Japan. Median patient age at diagnosis was 73 years (range, 18-95). Patients had a median diagnostic wait time of 40 days (range, 0-233), and the median follow-up was 28.8 months (range, 0.03-137.6).
A multivariate analysis revealed some patient characteristics, such as sex, International Prognostic Index (IPI) score, and course of therapy, to be predictors of survival outcomes, but diagnostic wait time was not independently predictive of overall survival (OS) or progression-free survival (PFS).
Diagnostic wait time did, however, show an interaction effect for survival outcomes when patients were grouped according to IPI scores. For patients with IPI scores of 3 or higher, an extended diagnostic wait time appeared related to poorer prognosis (for OS, P =.026 for the interaction between diagnostic wait time and grouped IPI; for PFS, P =.021 for the interaction between DWT and grouped IPI).
Some patients with IPI scores below 3 showed poor survival even with early diagnosis. The researchers noted that outcomes within this subpopulation may have obscured a relationship between diagnostic wait time and survival in the broader population. They suggested that, in some cases, early diagnosis in patients with low IPI scores may be linked to more aggressive disease.
“In conclusion, the [diagnostic wait time] did not worsen survival outcomes in the entire study population of DLBCL patients,” the authors wrote. “However, in patients with IPI [score of 3 or higher] at the time of diagnosis, there was a steady correlation between [diagnostic wait time] and survival outcomes.”
- Lee S, Fujita K, Negoro E, et al. The impact of diagnostic wait time on the survival of patients with diffuse large B-cell lymphoma: effect modification by the International Prognostic Index [published online June 27, 2019]. Br J Haematol. doi:10.1111/bjh.16078