Background Extranodal NK/T-cell lymphoma, nasal type (ENKTCL-NT) is an aggressive lymphoma associated with Epstein–Barr virus infection, with a known geographic and racial predilection for certain Asian and Latin American countries (Crit Rev Oncol Hematol, PMID: 33493634). In the United States, the highest incidence is observed among Hispanic White Americans and Asian/Pacific Islanders (J Clin Oncol, PMID: 26962200). Prior studies have reported no significant differences in overall survival (OS) based on gender or race (JMIR Form Res, PMID: 40373215). However, limited data exists regarding outcomes between academic and community programs. This study aims to explore whether the type of treatment facility, along with sociodemographic factors, insurance, and access to care, affects survival in patients with ENKTCL-NT.Methods We conducted a retrospective cohort study of patients diagnosed with ENKTCL-NT between 2004 and 2022 using data from the National Cancer Database (NCDB). Patient demographics, clinical features, socioeconomic indicators, time to treatment intervals, treatment modalities, and survival metrics were compared between academic cancer programs (ACPs) and community cancer programs (CCPs). ACPs included academic and research programs, including NCI-designated comprehensive cancer centers. CCPs comprised community, comprehensive community, and integrated network cancer programs. Survival analysis was performed using Kaplan-Meier (KM) curves. Adjusted median survival times were calculated using a Cox proportional hazards model, adjusting for age, ethnicity, insurance status, Charlson-Deyo comorbidity score, and Great Circle Distance to the treatment center.

Results A total of 2,660 patients diagnosed with ENKTCL-NT were included: 1,450 (55%) treated at ACPs and 613 (23%) at CCPs; 597 patients (22%). Patients treated at CCPs were older at diagnosis, with a median age of 63 vs. 59 years, (p < 0.001), and a higher proportion of people aged ≥ 60 years (60% vs. 48%). The stage distribution was comparable between the two groups: 60% of ACP patients and 59% of CCP patients were diagnosed with stage I/II disease, while 29% of ACP patients and 28% of CCP patients presented with stage III/IV disease.

Race and ethnicity distribution showed that ACPs saw more patients belonging to minority groups, with Hispanic patients accounting for 21% of ACP cases and 17% of CCP cases. Blacks accounted for 9.7% of ACP cases and 3.8% CCP cases.

Insurance coverage differed significantly, with CCPs seeing more Medicare patients (43% vs. 31%), whereas ACPs saw more Medicaid (14 vs. 9%) and uninsured (7 vs. 4%) patients (p<0.001). Both facility types had the same rates of private insurance (42%).

Regarding treatment patterns, patients at ACPs were more likely to receive treatment (71% vs. 65%, p = 0.002), and initiated therapy slightly sooner (median: 21 vs. 22 days; p < 0.001). A higher proportion of CCP patients received no treatment (7% vs. 5%, p = 0.002). There were similar rates of radiation utilization between facilities (53% in ACPs and 51% in CCPs).

Survival outcomes by facility type showed modest differences. For patients treated at ACPs, KM-estimated OS at 2, 5, and 10 years was 51%, 43%, and 35%, respectively. In CCPs, survival was 51%, 40%, and 31%, respectively. These differences were not statistically significant, with an adjusted median overall survival of 2.09 years for ACPs vs. 2.17 years for CCPs (p = 0.559).ConclusionsIn this nationally representative cohort of 2,660 patients with ENKTCL-NT, our analysis demonstrated similar survival outcomes between academic and community cancer programs. Despite differences in demographics, insurance coverage, and treatment patterns, these factors did not translate into significant difference in overall survival and long-term survival rates. These findings suggest that current standards of care may be effectively implemented across diverse settings, although subtle differences in early treatment access and comorbidity profiles warrant further investigation.

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2025
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