Health Impacts of Long-Term NO2 Exposure and Inequalities among the Chinese Population from 2013 to 2020.

Nitrogen dioxide (NO2) is associated with mortality and many other adverse health outcomes. In 2021, the World Health Organization established a new NO2 air quality guideline (AQG) (annual average <10 µg/m3). However, the burden of diseases attributable to long-term NO2 exposure above the AQG is unknown in China. Nitrogen oxide is a major air pollutant in populous cities, which are disproportionately impacted by NO2; this represents a form of environmental inequality. We conducted a nationwide risk assessment of premature deaths attributable to long-term NO2 exposure from 2013 to 2020 based on the exposure-response relationship, high-resolution annual NO2 concentrations, and gridded population data (considering sex, age, and residence [urban vs rural]). We calculated health metrics including attributable deaths, years of life lost (YLL), and loss of life expectancy (LLE). Inequality in the distribution of attributable deaths and YLLs was evaluated by the Lorenz curve and Gini index. According to the health impact assessments, in 2013, long-term NO2 exposure contributed to 315,847 (95% confidence interval [CI]: 306,709-319,269) premature deaths, 7.90 (7.68-7.99) million YLLs, and an LLE of 0.51 (0.50-0.52) years. The high-risk subgroup (top 20%) accounted for 85.7% of all NO2-related deaths and 85.2% of YLLs, resulting in Gini index values of 0.81 and 0.67, respectively. From 2013 to 2020, the estimated health impact from NO2 exposure was significantly reduced, but inequality displayed a slightly increasing trend. Our study revealed a considerable burden of NO2-related deaths in China, which were disproportionally frequent in a small high-risk subgroup. Future clean air initiatives should focus not only on reducing the average level of NO2 exposure but also minimizing inequality.

Trend of the mortality of major liver diseases and its impact on life expectancy in China from 2006 to 2017.

BACKGROUND: Liver diseases are the serious cause of death in China. We aim to describe the trends and disparities of major liver disease mortality rates and the loss of life expectancy (LLE) in China. METHODS: Annual percentage change (APC) and average APC (AAPC) were calculated using the Joinpoint regression model. LLE was calculated using cause eliminated life table. RESULTS: From 2006 to 2017, the overall age-standardized mortality rate (ASMR) of liver cirrhosis lightly declined (AAPC: -2.97%), whereas the ASMR of viral hepatitis and liver cancer remained stable. Viral hepatitis (AAPC: -4.36%) and liver cirrhosis (AAPC: -4.35%) ASMRs both declined for females. The highest ASMRs of viral hepatitis and liver cirrhosis were in the west region, while that of liver cancer was in the middle region. The ASMRs of liver cirrhosis in the middle region and liver cancer in the east region significantly decreased. The means of LLE on viral hepatitis, liver cirrhosis and liver cancer were 0.05, 0.1 and 0.46 years, respectively. CONCLUSIONS: The burden of liver diseases is still severe and there are disparities between genders and different regions in China. Accurate early diagnostic approaches for high-risk populations should be established to eliminate the burden of liver diseases.

Cost-effectiveness evaluation of mammography screening program in Taiwan: Adjusting different distributions of age and calendar year for real world data.

BACKGROUND/PURPOSE: We estimated loss-of-life expectancy (LE) and lifetime medical expenditures (LME) stratified by stages to evaluate the cost-effectiveness of breast cancer (BC) screening in Taiwan. METHODS: We interlinked four national databases- Cancer Registry, Mortality Registry, National Health Insurance Claim, and Mammography Screening. A cohort of 123,221 BC was identified during 2002-2015 and followed until December 31, 2017. We estimated LE and loss-of-LE by rolling extrapolation algorithm using age-, sex-, and calendar-year-matched referents simulated from vital statistics. LME was estimated by multiplying monthly cost with survival probability and adjusted for annual discount rate. We calculated incremental cost-effectiveness ratio (ICER) by comparing the loss-of-LE of those detected by screening versus non-screening after accounting for administration fees and radiation-related excess BC. RESULTS: The LEs of stages I, II, III, and IV were 31.4, 27.2, 20.0, and 5.2 years, respectively, while the loss-of-LEs were 1.2, 4.9, 11.7, and 25.0 years with corresponding LMEs of US$ 73,791, 79,496, 89,962, and 66,981, respectively. The difference in LE between stages I and IV was 26.2 years while that of loss-of-LE was 23.8 years, which implies that a potential lead time bias may exist if diagnosis at younger ages for earlier stages were not adjusted for. The ICER of mammography seemed cost-saving after the coverage exceeded half a million. CONCLUSION: Mammography could detect BC early and be cost-saving after adjustment for different distributions of age and calendar year of diagnosis. Future studies exploring healthcare expenditure and impaired quality of life for false-positive cases are warranted.

Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions.

AIMS: Ambient air pollution is a major health risk, leading to respiratory and cardiovascular mortality. A recent Global Exposure Mortality Model, based on an unmatched number of cohort studies in many countries, provides new hazard ratio functions, calling for re-evaluation of the disease burden. Accordingly, we estimated excess cardiovascular mortality attributed to air pollution in Europe. METHODS AND RESULTS: The new hazard ratio functions have been combined with ambient air pollution exposure data to estimate the impacts in Europe and the 28 countries of the European Union (EU-28). The annual excess mortality rate from ambient air pollution in Europe is 790 000 [95% confidence interval (95% CI) 645 000-934 000], and 659 000 (95% CI 537 000-775 000) in the EU-28. Between 40% and 80% are due to cardiovascular events, which dominate health outcomes. The upper limit includes events attributed to other non-communicable diseases, which are currently not specified. These estimates exceed recent analyses, such as the Global Burden of Disease for 2015, by more than a factor of two. We estimate that air pollution reduces the mean life expectancy in Europe by about 2.2 years with an annual, attributable per capita mortality rate in Europe of 133/100 000 per year. CONCLUSION: We provide new data based on novel hazard ratio functions suggesting that the health impacts attributable to ambient air pollution in Europe are substantially higher than previously assumed, though subject to considerable uncertainty. Our results imply that replacing fossil fuels by clean, renewable energy sources could substantially reduce the loss of life expectancy from air pollution.

Impact of updating the non-radiation parameters in the ICRP 103 detriment model.

The radiation detriment in ICRP 103 is defined as the product of the organ-specific risk coefficient and the damage that may be associated with a cancer type or hereditary effect. This is used to indicate a weighted risk according to the radiation sensitivity of different organs and the severity of damage that may possibly arise. While the risk refers to radiation exposure parameters, the extent of damage is independent of radiation. The parameters that are not affected by radiation are lethality, impairment of quality of life, and reduced life expectancy, which are considered as quantities associated with the severity of disease or damage. The damage and thus the detriment appear to be mostly affected by lethality, which is the quotient of the age-standardized mortality rate to the incidence rate. The analysis of the detriment presented in this paper focuses on the influence of the lethality on the detriment from 1980 to 2012 in the USA and Germany. While the lethality in this period covering more than three decades has decreased approximately linearly by 30% (both USA and Germany), within the same period the detriment declined only by 13% in the USA and by 15% in Germany. If only based on these two countries, an update on the detriment parameters with reference to 2007, when ICRP 103 was released, would result in a reduced weighted risk, i.e. the radiation detriment would be reduced by 10 to 15% from originally 5.7% per Sv for the whole population to roughly 5% per Sv.

Enrichment and assessment of the health risks posed by heavy metals in PM1 in Changji, Xinjiang, China.

The present study aims to investigate the influence of human activity on heavy metals in a typical arid urban area of China and assess human health risks posed by heavy metals in PM1 (particles <1.0 µm in diameter) for different people. In this paper, Changji (Xinjiang, China) was selected as the study area, and samples were collected from March 2014 to March 2015. A total 14 elements in PM1 were quantified using ICP-MS. An enrichment factor (EF) was used to assess the influence of human activity on the contamination of these metals. The results indicated that Mn was not enriched; Co, Cu, Cr, Ni, Tl, and V were slightly enriched; Mo, Pb, and Sb were moderately enriched; and Ag, As, and Cd were strongly enriched. To assess the health risks associated with inhaling PM1, the risk assessment code and loss in life expectancy based on the individual metals were calculated. The results showed that the elements Ag, Cu, Mo, Pb, Sb, Tl, and V in PM1 posed low levels of non-carcinogenic risks, but these metals may still pose risks to certain susceptible populations. In addition, the results also showed that As, Co, and Cr posed an appreciable carcinogenic risk, while Cd and Ni posed low levels of carcinogenic risk. The total predicted loss of life expectancy caused by the three metals As, Co, and Ni was 63.67 d for the elderly, 30.95 d for adult males, 26.62 d for adult females, and 48.22 d for children. Therefore, the safety of the elderly and children exposed to PM1 should be given more attention than the safety of adults. The results from this study demonstrate that the health risks posed by heavy metals in PM1 in Changji, Xinjiang, China should be examined.

Impact of cancer diagnosis on life expectancy by area-level socioeconomic groups in New South Wales, Australia: a population-based study.

OBJECTIVE: Improvement in cancer survival over recent decades has not been accompanied by a narrowing of socioeconomic disparities. This study aimed to quantify the loss of life expectancy (LOLE) resulting from a cancer diagnosis and examine disparities in LOLE based on area-level socioeconomic status (SES). METHODS: Data were collected for all people between 50 and 89 years of age who were diagnosed with cancer, registered in the NSW Cancer Registry between 2001 and 2019, and underwent mortality follow-up evaluations until December 2020. Flexible parametric survival models were fitted to estimate the LOLE by gender and area-level SES for 12 common cancers. RESULTS: Of 422,680 people with cancer, 24% and 18% lived in the most and least disadvantaged areas, respectively. Patients from the most disadvantaged areas had a significantly greater average LOLE than patients from the least disadvantaged areas for cancers with high survival rates, including prostate [2.9 years (95% CI: 2.5-3.2 years) vs. 1.6 years (95% CI: 1.3-1.9 years)] and breast cancer [1.6 years (95% CI: 1.4-1.8 years) vs. 1.2 years (95% CI: 1.0-1.4 years)]. The highest average LOLE occurred in males residing in the most disadvantaged areas with pancreatic [16.5 years (95% CI: 16.1-16.8 years) vs. 16.2 years (95% CI: 15.7-16.7 years)] and liver cancer [15.5 years (95% CI: 15.0-16.0 years) vs. 14.7 years (95% CI: 14.0-15.5 years)]. Females residing in the least disadvantaged areas with thyroid cancer [0.9 years (95% CI: 0.4-1.4 years) vs. 0.6 years (95% CI: 0.2-1.0 years)] or melanoma [0.9 years (95% CI: 0.8-1.1 years) vs. 0.7 years (95% CI: 0.5-0.8 years)] had the lowest average LOLE. CONCLUSIONS: Patients from the most disadvantaged areas had the highest LOLE with SES-based differences greatest for patients diagnosed with cancer at an early stage or cancers with higher survival rates, suggesting the need to prioritise early detection and reduce treatment-related barriers and survivorship challenges to improve life expectancy.

Lifetime risk, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for psoriasis in Taiwan: a nationwide cohort followed from 2000 to 2017.

Background: Patients with psoriasis have a significant disease burden throughout the life course. Nevertheless, the lifetime risk and disease burden of psoriasis across the entire lifespan is rarely quantified in an easily understandable way. Objective: To estimate the cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for incident psoriasis. Design and methods: Using real-world nationwide data from the National Health Insurance Research Database of Taiwan for 2000-2017, along with the life tables of vital statistics, we estimated cumulative incidence rate, life expectancy, loss-of-life expectancy, and lifetime healthcare expenditures for those with psoriasis using a semi-parametric survival extrapolation method. Results: A total of 217,924 new psoriasis cases were identified. The lifetime risk of psoriasis in patients aged 18-80 for both sexes decreased in Taiwan with a cumulative incidence rate of 7.93% in 2000 to 3.25% in 2017. The mean (±standard error) life expectancy after diagnosis was 27.11 (± 1.15) and 27.14 (±1.17) years for patients with moderate-to-severe psoriasis and psoriatic arthritis, respectively. Patients with moderate-to-severe psoriasis and psoriatic arthritis had a mean (±standard error) loss-of-life expectancy of 6.41 (±1.16) and 6.48 (±1.17) due to psoriasis, respectively. Male patients have higher lifetime and annual lifetime healthcare expenditures than female. Mean life expectancy, loss-of-life expectancy, and lifetime cost were relatively higher for younger patients. Conclusion: Among psoriatic patients, patients with moderate-to-severe psoriasis and psoriatic arthritis had substantial years of life lost, particularly for younger patients. Our results provide a reliable estimation of lifetime disease burden, and these estimates will help health authorities in cost-effectiveness assessments of public health interventions and allocation of services resources to minimize loss-of-life expectancy, and lifetime healthcare expenditures in patients with psoriasis.

Number of life-years lost at the time of diagnosis and several years post-diagnosis in patients with solid malignancies: a population-based study in the Netherlands, 1989-2019.

Background: Loss of life expectancy (LOLE) may provide more intuitive information on the impact of cancer than relative survival over a fixed time horizon (e.g., 5-year relative survival). We aimed to assess the evolution of the LOLE using a nationwide, population-based cohort including patients diagnosed with one of 17 most frequent solid malignancies. Methods: From the Netherlands Cancer Registry, we selected adult patients diagnosed with one of the 17 most frequent solid malignancies in the Netherlands during 1989-2019, with survival follow-up until 2022. We used flexible parametric survival models to estimate the LOLE at diagnosis and the LOLE after surviving several years post-diagnosis (conditional LOLE; CLOLE) by cancer type, calendar year, age, sex, and disease stage. Findings: For all cancers combined, the LOLE consistently decreased from 1989 to 2019. This decrease was most pronounced for males with prostate cancer (e.g., from 6.9 [95% confidence interval [CI], 6.7-7.1] to 2.7 [95% CI, 2.5-3.0] for 65-year-olds) and females with breast cancer (e.g., from 6.6 [95% CI, 6.4-6.7] to 1.9 [95% CI, 1.8-2.0] for 65-year-olds). The LOLE among patients with cancers of the head and neck or the central nervous system remained constant over time. Overall, the CLOLE showed that the life years lost among patients with cancer decreased with each additional year survived post-diagnosis. For example, the LOLE at diagnosis for 65-year-old females diagnosed with breast cancer in 2019 was 1.9 [95% CI, 1.8-2.0] compared with 1.7 [95% CI, 1.6-1.8], 1.0 [95% CI, 0.9-1.1], and 0.5 [95% CI, 0.5-0.6] when surviving one, five, and ten years post-diagnosis, respectively. Estimates for other combinations of patient and tumour characteristics are available in a publicly available web-based application. Interpretation: Our findings suggested that the evolution of LOLE substantially varies across cancer type, age, and disease stage. LOLE estimates help patients better understand the impact of their specific cancer diagnosis on their life expectancy. Funding: None.

Loss of life expectancy due to respiratory infectious diseases: findings from the global burden of disease study in 195 countries and territories 1990-2017.

Understanding of the patterns of and changes in mortality from respiratory infectious diseases (RID) and its contribution to loss of life expectancy (LE) is inadequate in the existing literature. With rapid sociodemographic changes globally, and the current COVID-19 pandemic, it is timely to revisit the disease burden of RID. Using the approaches of life table and cause-eliminated life table based on data from the Global Burden of Disease Study (GBD), the study analyses loss of LE due to RID in 195 countries/territories and its changes during the period 1990-2017. Results indicate that loss of LE due to RID stood at 1.29 years globally in 2017 globally and varied widely by age, gender, and geographic location, with men, elderly people, and populations in middle/low income countries/territories suffering a disproportionately high loss of LE due to RID. Additionally, loss of LE due to RID decreased remarkably by 0.97 years globally during the period 1990-2017 but increased slightly among populations older than 70 years and in many high income countries/territories. Results suggest that RID still pose a severe threat for population and public health, and that amid dramatic sociodemographic changes globally, the disease burden of RID may resurge. The study presents the first examination of the life-shortening effect of RID at the global and country/territory levels, providing new understanding of the changing disease burden of RID and shedding light on the potential consequences of the current COVID-19 pandemic.

Modeling transmission of hexavalent chromium concentration and its health cost with a water quality analysis simulation program.

In this study, the Water Quality Analysis Simulation Program (WASP7) was used to evaluate the transmission of hexavalent chromium (Cr(VI)) contamination in a water-sediment system and its flux into cultivated soils. The agricultural areas adjacent to the Wu River in Taiwan were taken as the study area, as these soils were heavily polluted with Cr(VI) concentrations of 2173-3271 µg/kg. The rates of accumulation of Cr(VI) are affected by the distance from the source of contamination and the size and type of cultivated areas. The highest concentrations of Cr(VI) (4.27 mg/kg) were detected in soil from Changhua city and correlated with the greater risk of gastric cancer in residents. Specifically, the risk of gastric cancer due to Cr(VI) contamination of agricultural soil was 3 × 10 - 7 - 15.2 × 10 - 6 in Taichung city (upstream) and 1.3 × 10 - 6 - 76.3 × 10 - 6 in Changhua county (downstream). The values of statistical life-years (VSLYs) were US$6.2-10 million for rice, US$42-60 million for corn, and US$360-580 million for other vegetables, respectively, each year. It is critical that techniques other than source reduction are used to reduce human exposure to Cr(VI), such as chemical oxidation or ion-exchange treatment to remove Cr(VI) from factory wastewaters, prior to their discharge into rivers. PRACTITIONER POINTS: This study evaluated the transmission of hexavalent chromium (Cr(VI)) contamination in a water-sediment-soil system. Maximum concentrations of Cr(VI) most rapidly accumulated in the smallest cultivated areas. The highest concentrations of Cr(VI) (3.3 mg/kg) were correlated with the greater risk of gastric cancer. Young children had a threefold greater risk of gastric cancer than adults. Techniques other than source reduction are prior to their discharge into rivers.

Life expectancy (LE) and loss-of-LE for patients with chronic obstructive pulmonary disease.

BACKGROUND AND OBJECTIVES: Prognosis of COPD is usually expressed as a 3-year survival rate, which might not be easily understood by lay people. This study estimates the life expectancy (LE) and loss-of-LE for COPD patients with different GOLD stages and patients with a history of acute exacerbation (AE) requiring hospitalization (severe AE) in the preceding year. METHODS: 532 patients who were diagnosed with COPD according to the GOLD criteria at NCKU hospital between 2006 and 2016 were recruited. Survival was estimated by Kaplan-Meier method, and extrapolated to lifetime to obtain the LE. The loss-of-LE was quantified by subtracting the LE of the COPD cohort from national life tables. The survival of patients with severe AE history was validated by a nation-wide cohort from the National Health Insurance dataset. RESULTS: The survival of patients with severe stage COPD (GOLD grades 3 and 4) was almost the same as those patients with a history of severe AE and the loss-of-LE for the former and the latter were 9.3 (1.1) and 9.4 (1.3) years, respectively. The nation-wide cohort with severe AE history (n = 44,764) showed a loss-of-LE of 8.3 (0.1) years. The loss-of-LE of patients with moderate stage COPD (GOLD grade 2) was 6.2 years, but no reduction in LE was noted for mild stage COPD (GOLD grade 1). CONCLUSIONS: We successfully estimated LE and loss of LE in COPD patients under the GOLD criteria. The survival of severe stage COPD patients is almost the same as those with severe AE history, or about 8-9 years of life lost.

Impact of area-level socioeconomic status and accessibility to treatment on life expectancy after a cancer diagnosis in Queensland, Australia.

AIMS: This study quantifies geographic inequities in loss of life expectancy (LOLE) by area-level socioeconomic status (SES) and accessibility to treatment. METHODS: Analysis was conducted using a population-based cancer-registry cohort (n = 371,570) of Queensland (Australia) residents aged 50-89 years, diagnosed between 1997-2016. Flexible parametric survival models were used to estimate LOLE by area-level SES and accessibility for all invasive cancers and the five leading cancers. The gain in life years that could be achieved if all cancer patients experienced the same relative survival as those in the least disadvantaged-high accessibility category was estimated for the 2016 cohort. RESULTS: For all invasive cancers, men living in the most disadvantaged areas lost 34 % of life expectancy due to their cancer diagnosis, while those from the least disadvantaged areas lost 25 %. The corresponding percentages for women were 33 % and 23 %. Accessibility had a lower impact on LOLE than SES, with patients from low accessibility areas losing 0-4 % more life expectancy than those from high accessibility areas. For cancer patients diagnosed in 2016 (n = 24,423), an estimated 101,387 life years will be lost. This would be reduced by 19 % if all patients experienced the same relative survival as those from the least disadvantaged-high accessibility areas. CONCLUSION: The impact of a cancer diagnosis on remaining life expectancy varies by geographical area. Establishing reasons why area disadvantage impacts on life expectancy is crucial to inform subsequent interventions that could increase the life expectancy of cancer patients from more disadvantaged areas.

Loss of life expectancy from air pollution compared to other risk factors: a worldwide perspective.

AIMS: Long-term exposure of humans to air pollution enhances the risk of cardiovascular and respiratory diseases. A novel Global Exposure Mortality Model (GEMM) has been derived from many cohort studies, providing much-improved coverage of the exposure to fine particulate matter (PM2.5). We applied the GEMM to assess excess mortality attributable to ambient air pollution on a global scale and compare to other risk factors. METHODS AND RESULTS: We used a data-informed atmospheric model to calculate worldwide exposure to PM2.5 and ozone pollution, which was combined with the GEMM to estimate disease-specific excess mortality and loss of life expectancy (LLE) in 2015. Using this model, we investigated the effects of different pollution sources, distinguishing between natural (wildfires, aeolian dust) and anthropogenic emissions, including fossil fuel use. Global excess mortality from all ambient air pollution is estimated at 8.8 (7.11-10.41) million/year, with an LLE of 2.9 (2.3-3.5) years, being a factor of two higher than earlier estimates, and exceeding that of tobacco smoking. The global mean mortality rate of about 120 per 100 000 people/year is much exceeded in East Asia (196 per 100 000/year) and Europe (133 per 100 000/year). Without fossil fuel emissions, the global mean life expectancy would increase by 1.1 (0.9-1.2) years and 1.7 (1.4-2.0) years by removing all potentially controllable anthropogenic emissions. Because aeolian dust and wildfire emission control is impracticable, significant LLE is unavoidable. CONCLUSION: Ambient air pollution is one of the main global health risks, causing significant excess mortality and LLE, especially through cardiovascular diseases. It causes an LLE that rivals that of tobacco smoking. The global mean LLE from air pollution strongly exceeds that by violence (all forms together), i.e. by an order of magnitude (LLE being 2.9 and 0.3 years, respectively).

Evaluation of hexavalent chromium concentration in water and its health risk with a system dynamics model.

This study is the first to use reliable data sources to establish a reasonable mass balance of Cr(VI) contamination in river water, sediment, and farmland soil. A system dynamics model was used to establish the interrelationships among water, Cr(VI) contamination, and health effects in the Wu River watershed (between Taichung city and Changhua county) between 2018 and 2048 (30 years). The results show very little Cr(VI) contamination in rivers; most flowed downstream or settled in sediment, and the accumulation of Cr(VI) in the sediment increased throughout the study period. The highest Cr(VI) concentrations in farmland soil (338.46 mg/kg) were reached in Changhua county as a result of greater Cr(VI) contamination from upstream and local factories. This Cr(VI) contamination led to gastric cancer risks of 5.24 × 10-4 and 4.38 × 10-6 in Changhua county and Taichung city, respectively. Although most of the Cr(VI) contamination was discharged from Taichung City, greater health risks and losses occurred downstream in Changhua county; medical costs were 55 times higher. For total quality control, a reduction rate of at least 68% should be reached in the study area. These findings will be helpful in predicting the transmission of Cr(VI) contamination over long study periods with a systematic model.

Risk of death, relapse or progression, and loss of life expectancy at different progression-free survival milestones in primary central nervous system lymphoma.

In this study, we analyzed the evolution of the prognosis of primary central nervous system lymphoma (PCNSL) patients as they reach selected progression-free survival (PFS) milestones after high-dose methotrexate (HD-MTX)-based therapy. In total, 258 and 146 patients were included from Denmark and British Columbia, respectively. All patients were diagnosed during 2000-2017. The 5-year PFS was 27% (95% CI 23; 32); however, for patients reaching 5 years of PFS, this increased to 71% (95% CI 57; 86). Within the first 5 years after diagnosis, patients lost 2.0 years (95% CI 1.8; 2.2) when compared to a similar background population. This reduced to 0.5 years (95% CI 0.2; 0.9) for patients reaching 5 years of PFS. Treatment with rituximab was associated with improved outcomes. The prognosis of patients with PCNSL treated with HD-MTX-based regimens in this cohort is poor, although it improves as patients survive without progression/relapse. However, survival does not conclusively normalize to that of a similar background population.