Survival determinants in nodular sclerosis Hodgkin's lymphoma.

e22001 Background: Nodular sclerosis Hodgkin lymphoma (NSHL) is the most common subtype of classical Hodgkin lymphoma, with distinct histological and clinical characteristics. Understanding how demographic and treatment factors affect survival can enhance patient prognosis. Methods: The SEER database was analyzed to identify NSHL cases (9663/3, 9664/3, 9665/3, and 9667/3) diagnosed between 2000 and 2021. Extracted variables included age, sex, race, geographic region, treatment modalities (chemotherapy and radiotherapy), survival months, and vital status. Overall survival (OS) was assessed using the Kaplan-Meier method, while Cox regression models evaluated prognostic factors, with statistical significance set at p < 0.05. Data analysis was conducted in R. Results: A total of 23,480 patients were analyzed. Most were young (17,542; 74.7%), from metropolitan areas (21,053; 89.7%), and White (15,742; 67.0%). The gender distribution was nearly equal (49.7% male, 50.3% female). Chemotherapy was received by 88.8% of patients, and 33% underwent radiotherapy. Survival varied significantly by age, sex, race, and treatment (p < 0.001). Younger patients, females, and metropolitan residents had better survival rates at one, three, and five years. Black patients had the lowest five-year survival (85.6%), compared to Hispanic (88.2%), White (89.2%), and other racial groups (90.8%). Radiotherapy reduced mortality risk by 51% (HR = 0.49, 95% CI: 0.45–0.53), and chemotherapy improved five-year survival to 90.2% versus 77.4% for those not receiving it. Histological grading affected prognosis, with cellular grade having the highest five-year survival (89.1%), followed by grade 1 (84.7%) and grade 2 (82.3%). Multivariate analysis identified older age, male sex, non-metropolitan residency, and Black race as significant mortality predictors (p < 0.001). Grade 2 was linked to worse outcomes (HR = 1.36, 95% CI: 1.16–1.60), while grade 1 showed no significant effect (HR = 1.10, 95% CI: 0.95–1.27). Conclusions: Survival in NSHL is influenced by demographic and treatment factors. Younger patients, females, metropolitan residents, and those receiving chemotherapy or radiotherapy had better survival, whereas older age, male sex, Black race, and non-metropolitan residency were linked to poorer outcomes. Cellular histology showed the best prognosis, while higher-grade tumors were associated with worse survival. Addressing disparities and optimizing treatments are essential for improving outcomes.