Abstract

Lymphoma presenting splenic invasion as the primary manifestation poses unique diagnostic and therapeutic challenges. This study aims to systematically analyze the clinical features, prognostic factors, and outcomes of patients with splenic involvement as the initial presentation of lymphoma. A retrospective analysis was conducted on lymphoma patients diagnosed with splenic involvement confirmed by histopathological examination at our hospital from March 2011 to February 2023. A total of 113 patients were included based on predefined inclusion and exclusion criteria. The collected data encompassed clinical presentations, diagnostic methods, histopathological features, treatment regimens, and outcomes. Kaplan-Meier survival analysis was performed to generate survival curves for overall survival (OS) and progression-free survival (PFS), with statistical significance assessed using the log-rank test. Additionally, univariate and multivariate analyses utilizing Cox regression analyses were conducted to identify potential prognostic factors. According to the pathological results, there were 6 types of lymphoma: indolent lymphoma (n = 23.18 of splenic marginal zone lymphoma (SMZL), 4 of follicular lymphoma (FL), 1 of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL). Aggressive lymphoma (n = 90.74 of diffuse large B cell lymphoma (DLBCL), 10 of NK/T cell lymphoma, 4 of mantle cell lymphoma (MCL), 1 of T lymphoblastic lymphoma, 1 of EBV-positive T cell lymphoma). Diagnosis was confirmed by hollow needle biopsy in 42 patients and through diagnostic splenectomy in 71 patients. 12 patients underwent splenectomy alone while 59 received chemotherapy following splenectomy. The median follow-up time was 37.53 months (range 0 to 162.33 months). The overall 5 year survival (OS) rate for the entire cohort was 62.39% and the 5 year progression-free survival (PFS) rate was 53.98%. Among those who underwent splenectomy, the 5 year OS rate and 5 year PFS rate were 68.06 and 62.50%, which were superior to 52.44 and 37.80% for non-splenectomy patients (P = 0.009 and P < 0.001, respectively). These differences were also observed in the aggressive lymphoma subgroup (n = 90), the 5 year OS rate and 5 year PFS rate were 62.96 and 57.41%, which were also superior to 48.61 and 37.50% for non-splenectomy patients (P = 0.042 and P = 0.017, respectively). In the whole group (n = 110), multivariate model shows prolonged APTT (P = 0.024), virous treatments (P = 0.016) and elevated ferritin (P = 0.017) were independent predicted OS parameters. In aggressive lymphoma subtype (n = 87), treatment (P = 0.021) and prolonged APTT (P = 0.016) emerged as independent risk factors. In indolent lymphomas, no significant differences were found. In this group of lymphoma patients presenting with splenic invasion as the first manifestation, the pathological type was almost aggressive lymphoma, with DLBCL being the main subtype. Common clinical symptoms include elevated ferritin, prolonged APTT and high LDH levels. This study suggests that splenectomy should be considered for these patients when their overall condition allows for safe intervention. Splenectomy combined with chemotherapy can significantly improve the survival time of patients.