Abstract

Background Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) predominantly affects older adults and is characterized by a prolonged disease course. While overall survival has improved, the psychosocial impact, including suicide risk, remains underexplored.

Methods A retrospective cohort study was conducted using data from 95,517 patients diagnosed with CLL/SLL between 2000 and 2021, extracted from the SEER 17 registry. LASSO regression was utilized for variable selection, followed by univariate and multivariate Cox proportional hazards and Fine-Gray competing risk analyses to identify independent predictors. A nomogram was developed based on significant predictors and validated using time-dependent receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).

Results The cohort’s mean age was 69.2 years, with 21.6% aged ≥80 years and a male-to-female ratio of 1.5:1; 88.8% were White. Although the suicide rate was only 0.1%, multivariate analyses demonstrated that advanced age (≥80 years), male sex, single or non-married status, and lower median household income were significantly associated with increased suicide risk, while non-White race was associated with a lower risk. However, age lost statistical significance in the competing risk model. The nomogram demonstrated good discriminative ability, with area under the curve (AUC) values exceeding 0.71 at 3, 5, and 10 years in both training and validation cohorts. Calibration plots indicated good agreement between predicted and observed outcomes, and DCA confirmed clinical utility.

Conclusions Sociodemographic factors, including sex, race, marital status, and income, are independently associated with suicide risk in CLL/SLL patients. The developed nomogram offers a practical, evidence-based tool for early identification of high-risk individuals, thereby facilitating targeted psychosocial interventions and improving survivorship care.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was supported by the National Natural Science Foundation of China, No. 82070174.

Author Declarations

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data Availability

The data analyzed in this study are from the SEER database (https://seer.cancer.gov/) that are available to the public.

AbbreviationsCLL/SLLChronic lymphocytic leukemia/small lymphocytic lymphomaChemochemotherapyCIconfidence intervalCODcause of deathDCAdecision curve analysisHRhazard rationOSoverall survivalROCreceiver operating characteristicSEERSurveillance, Epidemiology, and End Results.