We determined first- and second-line regimens, including hematopoietic stem cell transplantations, in all diffuse large B cell lymphoma (DLBCL) patients aged ≥20 yr (n = 1,888), registered at the Belgian Cancer Registry (2013-2015). Treatments were inferred from reimbursed drugs, and procedures registered in national health insurance databases. This real-world population-based study allows to assess patients usually excluded from clinical trials such as those with comorbidities, other malignancies (12%), and advanced age (28% are ≥80 yr old). Our data show that the majority of older patients are still started on first-line regimens with curative intent and a substantial proportion of them benefit from this approach. First-line treatments included full R-CHOP (44%), "incomplete" (R-)CHOP (18%), other anthracycline (14%), non-anthracycline (9%), only radiotherapy (3%), and no chemo-/radiotherapy (13%), with significant variation between age groups. The 5-year overall survival (OS) of all patients was 56% with a clear influence of age (78% [20-59 yr] versus 16% [≥85 yr]) and of the type of first-line treatments: full R-CHOP (72%), other anthracycline (58%), "incomplete" (R-)CHOP (47%), non-anthracycline (30%), only radiotherapy (30%), and no chemo-/radiotherapy (9%). Second-line therapy, presumed for refractory (7%) or relapsed disease (9%), was initiated in 252 patients (16%) and was predominantly (71%) platinum-based. The 5-year OS after second-line treatment without autologous stem cell transplantation (ASCT) was generally poor (11% in ≥70 yr versus 17% in <70 yr). An ASCT was performed in 5% of treated patients (n = 82). The 5-year OS after first- or second-line ASCT was similar (69% versus 66%). After adjustment, multivariable OS analyses indicated a significant hazard ratio (HR) for, among others, age (HR 1.81 to 5.95 for increasing age), performance status (PS) (HR 4.56 for PS >1 within 3 months from incidence), subsequent malignancies (HR 2.50), prior malignancies (HR 1.34), respiratory and diabetic comorbidity (HR 1.41 and 1.24), gender (HR 1.25 for males), and first-line treatment with full R-CHOP (HR 0.41) or other anthracycline-containing regimens (HR 0.72). Despite inherent limitations, patterns of care in DLBCL could be determined using an innovative approach based on Belgian health insurance data.
Uterine corpus cancer is the most frequent pelvic gynecological cancer in Belgium, however the adherence to the management guidelines is widely heterogeneous. In order to assess the quality of management, the EFFECT (EFFectiveness of Endometrial Cancer Treatment) project was initiated by the Anticancer Fund. Here we report the results regarding the surgical management of the patients included in EFFECT.
Methodology
Patients with uterine malignant tumors diagnosed between 2012 and 2016 were registered prospectively and on a voluntary basis in an online secured database hosted by the Belgian Cancer Registry (EFFECT study). Data on pathologic assessment, preoperative management, surgery, adjuvant treatment and follow-up were collected. We present the demographic characteristics, pathological assessment and surgical management of the whole study population.
Results
Overall, 4037 new cases were registered by 59 participating centers. The mean number of patients treated by each center was 65, 14 centers registered more than 100 patients during the whole period. The median patients' age was 69 years (range, 22–98 years). 95,5% of operated malignant tumors were carcinomas, 4,5% were sarcomas. 78% of the patients with a carcinoma and 75% of the sarcomas were FIGO stage I. 56% of operated patients were treated by minimally invasive surgery (laparoscopy or robotic-assisted laparoscopy), 36% by laparotomy and 7% by exclusive vaginal surgery. 44% of the operated patients had surgical lymph node staging (72% pelvic lymphadenectomy, 2% para-aortic lymphadenectomy, 22% pelvic and para-aortic lymphadenectomy). The median number of pelvic nodes resected was 17 (0–73) and for para-aortic nodes 11 (0–84).
Conclusion
Only half of the patients with clinical stage I were operated by minimally invasive surgery, 7% of patients were operated by exclusive vaginal surgery inappropriate for fit patients. Further analysis will assess the Quality of Care and hopefully permit to improve surgical and oncologic outcomes by the feedback provided to the different centers.
