Elderly patients with extranodal MZL: Academic vs community care outcomes.

Abstract

e13610 Background: Extranodal marginal zone lymphoma (EMZL) of mucosa-associated lymphoid tissue (MALT lymphoma) is the most common MZL subtype, typically affecting older adults and following an indolent course with a median survival > 10 years. Age ≥70 years is a key prognostic factor in MALT lymphoma and a component of the MALT-IPI, which incorporates age, stage, and LDH to stratify five-year event-free survival from ~70% to < 30%. Outcomes in older adults may be influenced by comorbidities and treatment setting, as Academic Cancer Programs (ACPs) offer greater diagnostic and therapeutic resources than Community Cancer Programs (CCPs). We evaluated institutional differences in treatment patterns and survival among elderly patients with extranodal MZL. Methods: We performed a retrospective cohort study using the National Cancer Database (NCDB), identifying patients aged ≥75 years diagnosed with extranodal MZL between 2004 and 2022. Patients were categorized by treatment facility type as ACP or CCP. Demographic, socioeconomic, clinical, and treatment characteristics were compared between cohorts. Overall survival (OS) was estimated using Kaplan–Meier methods and compared across facility types. Early mortality at 30 and 90 days and median OS were assessed by treatment setting. Results: Of 23,693 patients with extranodal MZL, 12,735 (54%) were treated at ACP and 10,958 (46%) at CCP. Patients at ACP were slightly younger (median age 80 vs 81 years; p < 0.001) and more racially diverse (Black 7% vs 4%; p < 0.001). CCP served communities with lower income and education (all p < 0.001) and had a higher comorbidity burden (Charlson-Deyo score ≥1: 31% vs 27%; p < 0.001). Medicare coverage was slightly higher at CCP (90% vs 88%). Treatment patterns differed by setting. Active surveillance was more frequent at ACPs (12% vs 10%; p < 0.001), while no treatment was more common at CCPs (13% vs 11%; p < 0.001). Systemic therapy initiation occurred earlier at CCP (median 37 vs 40 days; p = 0.002). Median OS was significantly longer at ACP than CCP (6 vs 5.6 years; p < 0.001). Thirty- and ninety-day mortality were lower at ACP (0.2% vs 0.4%, p = 0.002; 0.5% vs 0.7%, p = 0.006). The survival advantage persisted over time, with 2-, 5-, and 10-year OS rates of 79%, 57%, and 28% at ACP versus 77%, 54%, and 25% at CCP (all p < 0.001). Median follow-up was longer at ACP than at CCP (45.4 vs 42.9 months; p < 0.001). Conclusions: Among patients aged ≥75 years with extranodal MZL, treatment at ACP was associated with improved OS and lower early mortality, despite similar overall treatment utilization. Management strategies varied by facility type, and differences in socioeconomic factors, comorbidity burden, and access to multidisciplinary care may underlie observed outcome differences. These findings support efforts to reduce institutional disparities and improve access to high-quality oncology care for older adults with indolent lymphomas.