Sociodemographic And Facility Factors Associated With Stage I Versus Stage IV Diagnosis In Mycosis Fungoides: An Ncdb Analysis

Introduction: Mycosis fungoides (MF) is a rare primary cutaneous T-cell lymphoma defined by malignant proliferation of skin-homing CD4⁺ T cells. While early-stage MF carries excellent prognosis, diagnosis is often delayed due to resemblance to benign skin conditions. In contrast, stage IV has markedly poorer prognosis, with 5-year survival as low as 20–30%. Objective: To evaluate sociodemographic and facility characteristics associated with stage I versus stage IV MF diagnosis. Methods: Using the National Cancer Database, 5,624 patients with stage I or stage IV MF were analyzed by race, sex, facility type, age, ethnicity, insurance, income, education, rurality, geographic region, comorbidity score, and distance to treatment center. Multivariable logistic regression was used to estimate odds ratios (ORs) for factors associated with stage at diagnosis and mortality. The mortality analysis was restricted to 5,282 patients with known vital status. Results: Patients were predominantly White (75.1%), male (55.2%), and treated in academic facilities (79.1%). Stage IV patients, compared to stage I, were older (median 67 years vs. 62; OR = 1.03 per year increase), and more likely to be Black (1.63), Hispanic (1.72), Medicaid-insured (1.86), from lower-educational backgrounds, treated at non-academic facilities (1.37), comorbid with other conditions (2.05), and traveling farther for treatment (1.01 per mile; all p < 0.05). Stage IV disease was associated with higher odds of mortality (OR 6.80, 95% CI 5.26–8.78), with additional associations observed for older age, male sex, public insurance, lower income, non-academic facilities, and South or Midwest residence. Conclusions: In MF, older age, Black race, and socioeconomic barriers were associated with stage IV diagnosis, and stage IV disease was associated with higher odds of mortality.