Racial and Socioeconomic Disparities in Survival Outcomes of Mantle Cell Lymphoma: An Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database from 2000 to 2021

Introduction
Mantle Cell Lymphoma (MCL) is a rare class of B-cell non-Hodgkin lymphomas (NHL) characterized by an (11,14) translocation resulting in overexpression of the cyclin D1 (CCND1) gene. Mantle cell lymphoma often follows a difficult clinical course and challenging prognosis. Age and performance status play a role in overall prognosis. There needs to be more data on racial and socioeconomic disparities in the survival outcomes of MCL. Our analysis involved comparing survival outcomes of patients with mantle cell lymphoma based on race, rural-urban, and income.

Methods
Data from the Surveillance, Epidemiology, and End Results (SEER) database program was utilized to obtain the survival analysis data of Mantle Cell Lymphoma. Patient characteristics were expressed in proportions (%). Kaplan-Meier methods were used to estimate 5-year survival rates. Cox proportional hazards regression was used for multivariable modelling of the survival database. The difference between the observed number of events between each group was compared using a log-rank statistical test.

Results
We identified 11,450 patients with complete survival data who were analyzed by our study. 90.4% were whites, 4.1% were blacks, 0.7% were American Indian/Alaska Native, and 4.7% were Asian/Pacific Islander. The one and five-year survival by race/ethnicity were whites (83.6%, 60.3%), Blacks (83.8%, 61.3%), American Indian/Alaska Native (75.8%, 56.4%), Asian or Pacific Islander (82.5%, 60.3%). Urban residency was coded by counties in metropolitan areas with a population greater than 250,000, while non-metropolitan counties coded rural residency. The one and five-year survival by urban (83.8%,61.0%) and rural (82.3%,56.6%) was analyzed. The one and five-year survival by $40,000-$79,999 income (82.9%-58.5%) and >$80,000 income (84.5%, 63.1%) was also calculated. Race was a predictor of worse outcome, Black HR 0.98(95% CI; 0.87-1.1, p = 0.72), American Indian/Alaska Native HR 1.36 (95% CI; 1.02-1.8, p = 0.035), Asian or Pacific Islander HR 0.90 (95% CI; 0.79-1.0, p = 0.075). There was survival disparity by sex, Male (CI 95%; 1.06, 1.00-1.1)

Conclusion
Race and socioeconomic factors play a pertinent role in survival outcomes in patients with mantle cell lymphoma. A survival disparity by sex has also been noted. American Indian/Alaska Natives demonstrated a statistically significant higher hazard ratio compared to Whites, which was the reference.