Surgical management of stage IE/IIE primary pulmonary lymphomas: a propensity score matching study.

in Journal of thoracic disease by Jie Cao, Huahang Lin, Zhiyu Peng, Zhaokang Huang, Zetao Liu, Chenglin Guo, Jiandong Mei

TLDR

  • Surgery improves survival rates in patients with stage IE/IIE diffuse large B-cell lymphoma (DLBCL), but not in patients with other subtypes of primary pulmonary lymphoma.
  • Sublobectomy is a viable surgical option for patients with PPLs, particularly when complete resection is achieved.
  • Further research is needed to determine the optimal surgical strategy and treatment approach for patients with PPLs.

Abstract

Primary pulmonary lymphomas (PPLs) are rare malignancies that are frequently misdiagnosed due to their non-specific symptoms and ambiguous imaging findings. Although chemotherapy and radiation are typically the main treatment options, the role of surgery in managing PPLs remains uncertain. This study aimed to evaluate the impact of surgery on survival outcomes in patients with stage IE/IIE PPLs. We analyzed 2,693 patients with stage IE/IIE PPLs using Cox regression and Kaplan-Meier analyses to assess overall survival (OS) and cancer-specific survival (CSS). Subgroup analyses were performed based on histological subtypes, including mucosa-associated lymphoid tissue (MALT) lymphoma, diffuse large B-cell lymphoma (DLBCL), other non-Hodgkin's lymphoma (NHL), and Hodgkin's lymphoma (HL). Additionally, we analyzed tumor stage and patient characteristics. Propensity score matching (PSM) was applied to reduce potential biases. Among the patients, 1,013 underwent surgery, while 1,680 did not. After PSM, surgery was associated with significantly improved OS [hazard ratio (HR) =0.75, 95% confidence interval (CI): 0.66-0.86, P<0.001] and CSS (HR =0.66, 95% CI: 0.54-0.81, P<0.001). Notably, surgery significantly improved OS and CSS in patients with stage IE (OS: HR =0.62, 95% CI: 0.46-0.84, P=0.002; CSS: HR =0.57, 95% CI: 0.39-0.84, P=0.005) and stage IIE (OS: HR =0.64, 95% CI: 0.41-0.99, P=0.046; CSS: HR =0.47, 95% CI: 0.27-0.85, P=0.01) DLBCL. However, surgery did not significantly affect OS (P=0.24) or CSS (P=0.83) in patients with HL, stage IE/IIE MALT lymphoma (stage IE: OS, P=0.11; CSS, P=0.34; stage IIE: OS, P=0.40; CSS, P=0.75), or stage IE/IIE other NHL (stage IE: OS, P=0.050; CSS, P=0.46; stage IIE: OS, P=0.22; CSS, P=0.11). Additionally, sublobectomy demonstrated outcomes comparable to lobectomy/pneumonectomy in terms of OS and CSS for both stage IE (OS: HR =0.81, 95% CI: 0.63-1.06, P=0.13; CSS: HR =0.91, 95% CI: 0.58-1.43, P=0.70) and stage IIE (OS: HR =0.66, 95% CI: 0.40-1.09, P=0.10; CSS: HR =0.58, 95% CI: 0.26-1.29, P=0.18) PPLs. Surgery improves oncological outcomes for patients with stage IE/IIE DLBCL but does not provide survival benefits for MALT lymphoma, other NHL, or HL. Sublobectomy may be a viable surgical option when complete resection is achieved.

Overview

  • The study aimed to evaluate the impact of surgery on survival outcomes in patients with stage IE/IIE primary pulmonary lymphomas (PPLs).
  • The researchers analyzed 2,693 patients with stage IE/IIE PPLs using Cox regression and Kaplan-Meier analyses to assess overall survival (OS) and cancer-specific survival (CSS).
  • The primary objective was to determine whether surgery improves oncological outcomes in patients with PPLs, particularly in patients with diffuse large B-cell lymphoma (DLBCL).

Comparative Analysis & Findings

  • The study found that surgery was associated with significantly improved OS and CSS in patients with stage IE and stage IIE DLBCL.
  • However, surgery did not significantly affect OS or CSS in patients with Hodgkin's lymphoma (HL), MALT lymphoma, or other non-Hodgkin's lymphoma (NHL).
  • Sublobectomy demonstrated outcomes comparable to lobectomy/pneumonectomy in terms of OS and CSS for both stage IE and stage IIE PPLs.

Implications and Future Directions

  • The study suggests that surgery may be a viable option for patients with stage IE/IIE DLBCL, particularly those with complete resection.
  • Future research will focus on identifying the optimal surgical strategy for patients with PPLs and determining the role of surgery in combination with chemotherapy and radiation.
  • Additionally, the study highlights the importance of accurate diagnosis and staging of PPLs, as this may aid in determining the most appropriate treatment approach.
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