The impact of surgery on long-term survival of patients with primary intestinal non-Hodgkin lymphomas based on SEER database

Cuifen Zhang,Zeyu Liu,Linzhu Zhai,Lizhu Lin,Jiahao Tao,Xiaohong Zhang

doi:10.1038/s41598-021-02597-1

Abstract

Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial. We aimed to investigate the specific impact of surgery on survival of PINHL patients. Data from PINHL patients (aged > 18 years) with chemotherapy between 1983 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We concerned about overall survival (OS) and improved cancer-specific survival (CSS). Propensity score matching (PSM) analysis was also used to explore the reliability of the results to further control for confounding factors. Finally, we screened 3537 patients. Multivariate regression analysis showed that patients with surgery and chemotherapy had 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 confounding factors. 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. 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.

Highlights

Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial
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

Introduction

Evidence regarding the need for surgery for primary intestinal non-Hodgkin lymphoma (PINHL) patients with chemotherapy is limited and controversial. Multivariate regression analysis showed that patients with surgery and chemotherapy had 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 confounding factors. 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. We retrospectively assessed the impact of surgical and non-surgical management on survival outcomes in a large cohort of PINHL patients who had received chemotherapy in the Surveillance, Epidemiology, and End Results (SEER) Program

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