A comparative study of non-Hodgkin lymphoma between public versus private institution in a middle-income country: A report of 2,317 cases.
Authors: Vasquez Chavez Jule Franve , Diaz Alonso , Enriquez Daniel , Malpica Luis , Cabrejos Michaell , Arias Castillo Edwin Alfredo , Lopez Lourdes Isabel , Quintana Truyenque Shirley Milenca , Flores Claudio J. , Dueñas Daniela , Barrionuevo Carlos , Samanez Cesar Augusto 
Published: June 2021

e19569

Background: Non-Hodgkin lymphoma (NHL) is the most frequent hematological malignancy. B-cell (BCL) and T-cell (TCL) NHL subtypes differs in high income and low-and middle-income countries. In Peru, the healthcare system is divided mainly into public and private institutions. We aimed to describe the subtypes of NHL seen according to healthcare facilities. Methods: We reviewed medical records at National Cancer Institute and Oncosalud, both the leading public and private cancer centers in Peru, respectively. All patients diagnosed with NHL from 2015-2018 according to the 2016 WHO classification were included. Baseline characteristics were compared between public and private institutions using Student’s t test and Chi-square as appropriate. Results: A total of 2,317 NHL were included from both institutions. The median age was 61 years (range 15-99), 49.7% were male. Most patients NHL cases were encountered at the public institution (88.9%, n = 2,059); 84.4% (n = 1,957) were BCL and 15.5% (n = 360) TCL. Differences of BCL and TCL frequencies were seen among institutions. More BCL cases were seen at the private institution (96.6%, n = 230 versus 83.9%, n = 1,727, respectively) whereas TCL were common in the public institution (16.1%, n = 332 versus 11.8%, n = 28, respectively) (p < 0.035). The most frequent BCL was DLBCL with 70.0% (n = 1209) and 49.6% (n = 114) seen in public and private institutions, respectively (p < 0.001). The second most frequent BCL was follicular lymphoma (FL) with 10.8% (n = 187) and 20.4% (n = 47) seen in the public and private institutions, respectively (p < 0.001). Chronic lymphocytic lymphoma (CLL) and Burkitt lymphoma (BL) were most frequent in private institution (CLL 7%, n = 16 vs. 3.5%, n = 60, p = 0.017; BL 3.9%, n = 9 vs. 1.2%, n = 21, p = 0.004). The most frequent TCL was peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS) (27.7%, n = 92) for the public institution and mycosis fungoides (MF) (39.3%, n = 11) for the private institution. The second most frequent TCL was natural killer/TCL (NKTCL) (22.6%, n = 75) for the public institution, and PTCL, NOS (17.9%, n = 5) for the private institution. There was significant difference in the number of NKTCL and MF cases seen during the study period among institutions (NKTCL public 22.6%, n = 75 vs. private 3.6%, n = 1, p = 0.033; MF public 15.1%, n = 50 vs. private 39.3%, n = 11, p = 0.003). The presence of extranodal involvement was more frequent in the public institution (52.3%, n = 1,049 vs. 35.3%, n = 84, p < 0.001). Conclusions: The distribution of NHL differs according to the type of healthcare system in Peru. Extranodal involvement, TCL, DLBCL and NKTCL are more frequent in patients treated at the public cancer center than in private center. On the contrary BCL, FL, CLL, BL and MF are more frequent in private cancer center. Our institutions are currently building the largest registry of NHL patients diagnosed and treated in Peru.