Role of social status and social environment on net survival in patients with chronic lymphocytic leukemia: A high-resolution population-based study

B Delapierre; X Troussard; G Damaj; O Dejardin; L Tron

doi:10.1016/j.canep.2022.102292

Role of social status and social environment on net survival in patients with chronic lymphocytic leukemia: A high-resolution population-based study

Cancer Epidemiol. 2023 Feb:82:102292. doi: 10.1016/j.canep.2022.102292. Epub 2022 Nov 18.

Authors

B Delapierre¹, X Troussard², G Damaj³, O Dejardin⁴, L Tron⁵

Affiliations

¹ Department of Hematology, Institut d'hématologie de Basse-Normandie, University Hospital, Normandy University, School of Medicine, Caen, France; Department of Research, University Hospital, Caen, France; ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France. Electronic address: delapierre-ba@chu-caen.fr.
² Department of Research, University Hospital, Caen, France; Laboratory of Hematology, University Hospital, Caen, France; Registre Régional des Hémopathies malignes de Basse-Normandie, University Hospital of Caen, Caen, France.
³ Department of Hematology, Institut d'hématologie de Basse-Normandie, University Hospital, Normandy University, School of Medicine, Caen, France; Department of Research, University Hospital, Caen, France.
⁴ Department of Research, University Hospital, Caen, France; ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France.
⁵ ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France.

PMID: 36410088
DOI: 10.1016/j.canep.2022.102292

Abstract

Background: The prognostic roles of social status and social environment in chronic lymphocytic leukemia have been highlighted in some solid tumors but remain unclear in hematological malignancies. The objective of this study was to evaluate the influence of individual social status (with socioprofessional category, SPC) and social environment (with European deprivation index, EDI) on net survival in a high-resolution population with CLL.

Methods: We included CLL patients from the Regional Register of Hematological Malignancies in Normandy belonging to the French Network of Cancer Registries (Francim). The SPC variable was divided into 5 categories: farmers, craftsmen, higher employment, intermediate employment, and workers/employees. Net survival was used to estimate the excess of mortality in CLL independent of other possible causes of death using French life tables. Net survival was estimated with a nonparametric method (Pohar-Perme) and with a flexible excess mortality hazard model. Missing data were handled with multiple imputation.

Results: A total of 780 patients were included. The median follow-up was 7.9 years. The crude survival at 10 years was 50%, and the net survival at 10 years was 80%. In multivariate analysis, a higher age (EHR: 1.04 [1.01-1.07]), being a craftsman (EHR_{craftsmen/higher.employment}: 4.15 [0.86-20.15]), being a worker or an employee (EHR_{workers.employees/higher.employment}: 3.57 [1.19-10.7]), having a Binet staging of B or C (EHR: 3.43 [1.84-6.42]) and having a lymphocyte count > 15 G/L (EHR: 3.80 [2.17-6.65]) were statistically associated with a higher risk of excess mortality. EDI was not associated with excess mortality (EHR: 0.97 [0.90-1.04]).

Conclusion: Socioprofessional category was a prognostic factor for an excess of mortality in CLL. Craftsmen and workers/employees shared a worse prognosis than workers with higher employment. The social environment was not a prognostic factor. Further work should be performed to explore causal epidemiologic or biological factors and other hematological malignancies.

Keywords: Chronic lymphocytic leukemia; Net survival; Social environment; Social inequalities; Socioprofessional category.

MeSH terms

Hematologic Neoplasms*
Humans
Leukemia, Lymphocytic, Chronic, B-Cell* / epidemiology
Leukemia, Lymphocytic, Chronic, B-Cell* / pathology
Prognosis
Proportional Hazards Models
Social Status