Racial differences in survival and prognostic factors among patients with mycosis fungoides and Sézary syndrome: A systematic review and meta-analysis.

Abstract

e19112 Background: Mycosis Fungoides (MF) and its leukemic variant, Sezary Syndrome (SS), are the most common forms of cutaneous T-cell lymphoma. Racial differences in survival outcomes between white and black patients are contradictory between studies. Objective: To evaluate the survival outcomes among white and black patients with MF and to determine other prognostic factors of the disease. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted from inception through May 2025 to identify studies comparing survival outcomes and prognostic factors between Black and White patients with MF/SS. Review articles, clinical trials, gray literature, and studies not reporting survival outcomes by race were excluded. Meta-analysis was performed using RevMan software. Results: Out of 468 studies, 12 were included in the final analysis, comprising 16514 patients. White patients comprised 65.5%, whereas 16% were black. Black patients were diagnosed at younger ages (MD= -6.69, 95% CI = [-10.12, -3.27], p=0.0001). Black patients are significantly more likely to be diagnosed at higher stages at diagnosis compared to white patients (RR=1.34, 95% CI= [1.01, 2.03], p=0.0008). Also, black patients have worse Overall Survival (OS)compared to white patients (HR= 1.46, 95% CI= [1.33, 1.61], p=0.004) and a higher mortality rate compared to white patients (RR= 2.23, 95% CI= [0.61, 8.92], p=0.0004). Patients with advanced stage have 2.85 times worse survival than other patients (HR=2.85, 95% CI= [2.57, 3.15], p=0.0001) and patients with advanced age at diagnosis (>60 years) have 1.06 times worse OS compared to younger patients (HR= 1.06, 95% CI= [1.06, 1.07], p=0.00001). Advanced age (>60), late stages at diagnosis, erythroderma, and hypopigmented lesions were the most noticeable poor prognostic indicators of OS. Conclusions: Black patients are diagnosed at an earlier age and at later stages than white patients. Additionally, overall survival is significantly worse in black patients compared to white patients. This racial disparity warrants further investigation and correction of medical policies, socioeconomic factors, or biologic differences that may underlie these findings.