Cancer Res Treat.  2020 Oct;52(4):1262-1272. 10.4143/crt.2020.089.

Increasing Incidence of B-Cell Non-Hodgkin Lymphoma and Occurrence of Second Primary Malignancies in South Korea: 10-Year Follow-up Using the Korean National Health Information Database

• Kim JS
• Liu Y
• Ha KH
• Qiu H
• Rothwell LA
• Kim HC

• KMID: 2507951
• DOI: http://doi.org/10.4143/crt.2020.089

Abstract

Purpose
The epidemiology of B-cell non-Hodgkin lymphoma (BNHL) in Asia is not well described, and rates of second primary malignancies (SPM) in these patients are not known. We aimed to describe temporal changes in BNHL epidemiology and SPM incidence in Korea.
Materials and Methods
A retrospective cohort study used claims data from the National Health Insurance Service that provides universal healthcare coverage in Korea. Newly diagnosed patients aged at least 19 years with a confirmed diagnosis of one of six BNHL subtypes (diffuse large cell B-cell lymphoma [DLBCL], small lymphocytic and chronic lymphocytic [CLL/SLL], follicular lymphoma [FL], mantle cell lymphoma [MCL], marginal zone lymphoma [MZL], and lymphoplasmacytic lymphoma/Waldenström’s macroglobulinemia [WM]) during the period 2006-2015 were enrolled and followed up until death, dis-enrolment, or study end, whichever occurred first. Patients with pre-existing primary cancers prior to the diagnosis of BNHL were excluded.
Results
A total of 19,500 patients with newly diagnosed BNHL were identified out of 27,866 with non-Hodgkin lymphoma (NHL). DLBCL was the most frequently diagnosed subtype (41.9%-48.4% of NHL patients annually, 2011-2015). Standardized incidence of the six subtypes studied per 100,000 population increased from 5.74 in 2011 to 6.96 in 2015, with most increases in DLBCL, FL, and MZL. The incidence (95% confidence interval) of SPM per 100 person-years was 2.74 (2.26-3.29) for CLL/SLL, 2.43 (1.57-3.58) for MCL, 2.41 (2.10-2.76) for MZL, 2.23 (2.07-2.40) for DLBCL, 1.97 (1.61-2.38) for FL, and 1.41 (0.69-2.59) for WM.
Conclusion
BNHL has been increasingly diagnosed in Korea. High rates of SPM highlight the need for continued close monitoring to ensure early diagnosis and treatment.

Keyword

Non-Hodgkin lymphoma; Prevalence; Incidence; Korea; Second primary neoplasms

Figure

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  Fig. 1. Age-standardized incidence rates (95% confidence intervals) of B-cell non-Hodgkin lymphoma subtypes in South Korea, 2011-2015. Age-standardized rates were calculated by direct standardization method, using the 2011 Korean population as the reference. p-values for trend: DLBCL p < 0.001 (A), MZL p < 0.001 (B), CLL/SLL p=0.489 (C), MCL p=0.077 (D), FL p < 0.001 (E), WM p=0.661 (F). DLBCL, diffuse large B-cell lymphoma; MZL, marginal zone lymphoma; CLL/SLL, small lymphocytic lymphoma and chronic lymphocytic; MCL, mantle cell lymphoma; FL, follicular lymphoma; WM, Waldenström’s macroglobulinemia or lymphoplasmacytic lymphoma.

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  Fig. 2. Age-standardized prevalence (95% confidence intervals) of B-cell non-Hodgkin lymphoma subtypes in South Korea, 2011-2015. Age-standardized rates were calculated by direct standardization method, using the 2011 Korean population as the reference. p-values for trend: DLBCL p & 0.001 (A), MZL p & 0.001 (B), CLL/SLL p & 0.001 (C), MCL p & 0.001 (D), FL p & 0.001 (E), WM p & 0.001 (F). DLBCL, diffuse large B-cell lymphoma; MZL, marginal zone lymphoma; CLL/SLL, small lymphocytic lymphoma and chronic lymphocytic; MCL, mantle cell lymphoma; FL, follicular lymphoma; WM, Waldenström’s macroglobulinemia or lymphoplasmacytic lymphoma.

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  Fig. 3. Age-standardized all-cause mortality rates (95% confidence intervals) in patients with B-cell non-Hodgkin lymphoma subtypes in the Korean population, 2011-2015. Age-standardized rates were calculated by direct standardization method, using the 2011 Korean population as the reference. p-values for trend: DLBCL p < 0.010 (A), MZL p < 0.001 (B), CLL/SLL p < 0.001 (C), MCL p < 0.001 (D), FL p=0.937 (E), WM p=0.923 (F). DLBCL, diffuse large B-cell lymphoma; MZL, marginal zone lymphoma; CLL/SLL, small lymphocytic lymphoma and chronic lymphocytic; MCL, mantle cell lymphoma; FL, follicular lymphoma; WM, Waldenström’s macroglobulinemia or lymphoplasmacytic lymphoma.

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  Fig. 4. Overall survival after B-cell non-Hodgkin lymphoma diagnosis index date: follow-up of all patients enrolled from 2006-2015 and death from any cause. MZL, marginal zone lymphoma; FL, follicular lymphoma; DLBCL, diffuse large B-cell lymphoma; CLL/SLL, small lymphocytic lymphoma and chronic lymphocytic; MCL, mantle cell lymphoma; WM, Waldenström’s macroglobulinemia or lymphoplasmacytic lymphoma.

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  Fig. 5. Age-standardized incidence of B-cell non-Hodgkin lymphoma subtypes as reported fan Central Cancer Registry from 1999-2012 [2] and the National Health Information database from 2011-2015 (shaded). DLBCL, diffuse large B-cell lymphoma; CLL/SLL, small lymphocytic lymphoma and chronic lymphocytic; MCL, mantle cell lymphoma; FL, follicular lymphoma; MZL, marginal zone lymphoma.

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