Abstract
Background: Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial. However, there is a lack of large-scale multicenter studies for the specific analysis of this population. We aimed to investigate the specific impact of surgery on survival in a large cohort of PINHL patients (aged >18 years) with chemotherapy. Methods: For this retrospective cohort study, data from PINHL patients (aged >18 years) with chemotherapy between 1983 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database through strict acceptance and discharge standards. The primary and secondary objectives were to access improved overall survival (OS) and improved cancer-specific survival (CSS) with surgery, respectively. In addition to multiple regression analysis and stratification analysis adjusted for confounding factors, propensity score matching (PSM) analysis was used to explore the reliability of the results to further control for confounding factors. Findings: Data were collected from the SEER database for 8398 patients; 3537 met inclusion criteria. The median survival was 53 months. Multivariate regression analysis showed that patients with surgery and chemotherapy had significantly better OS (hazard ratio [HR] 0·83, 95% confidence interval [CI] 0·75–0·93; P=0·0009) and CSS (HR 0·87, 95% CI 0·77–0·99; P=0·0404) compared with the non-operation group after adjusting for age, gender, race, marital status, year of diagnosis, Ann Arbor stage, histology, tumor size, and radiation. In particular, histological subgroup analyses showed that patients with primary intestinal diffuse large B-cell lymphoma had a better prognosis with chemotherapy plus surgery compared with the non-operation group (HR 0·71, 95% CI 0·60–0·84; P for interaction=0·0067). After PSM analysis, compared with non-surgery, surgery remained associated with improved OS (HR 0·77, 95% CI 0·68–0·87; P<0·0001) and improved CSS (HR 0·82, 95% CI 0·72–0·95; P=0·008) adjusted for baseline differences. Interpretation: In the large cohort of PINHL patients with chemotherapy older than 18 years, surgery was associated with significantly improved OS and CSS before and after PSM analysis. Funding: Supported by grants from the National Natural Science Foundation of China (grant no. 81873147) and the Natural Science Foundation of Guangdong Province (grant no. 2020A1515011177). Declaration of Interest: All the authors declared that they have no conflict of interest.
Highlights
Primary intestinal non-Hodgkin lymphoma (PINHL) is the most involved site of all extranodal lymphomas except the stomach
Primary intestinal lymphoma has often been presented as a subgroup of gastrointestinal lymphoma in the study of primary gastrointestinal lymphoma, which mainly reported the optimal treatment algorithms aimed at gastric lymphoma; in contrast, studies of primary intestinal lymphoma alone are absent 5
Substantial progress has been achieved by the use of various conservative treatments over time 15, 16, which means that surgical treatment for the survival of PINHL may require transvaluation
Summary
Primary intestinal non-Hodgkin lymphoma (PINHL) is the most involved site of all extranodal lymphomas except the stomach. The incidence of extranodal lymphomas has been increasing among patients with non-Hodgkin lymphoma (NHL), reaching rates as high as 30%–50% 1. Among primary gastrointestinal non-Hodgkin lymphoma, 43%–75% occur in the stomach, 10%–35% in the small intestine, and 5%–25% in the colon and rectum 2. Intestinal lymphomas behave differently and have different survival rates compared with gastric lymphomas. Because of different anatomic locations in the gastrointestinal tract, PINHL mainly comprises diffuse large B cell lymphoma (DLBCL) and T cell lymphoma, while gastric lymphomas are mostly represented by the mucosa-associated lymphoid tissue (MALT) subtype. Gastric lymphoma doesn’t show better outcomes with chemotherapy and surgery which may be different from PINHL 3, 4. It is significant to conduct a study targeting PINHL as a separate entity 5
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