Division of Colorectal Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Gastrointest Surg. 2021 Mar;25(3):757-765. doi: 10.1007/s11605-020-04730-3. Epub 2020 Jul 14.
Primary small bowel non-Hodgkin's lymphoma is a rare disease representing 2% of small intestine malignancies. There is limited data delineating the optimal treatment for these heterogeneous tumors. We aim to examine relationships between different treatment modalities and surgical outcomes in patients with small bowel lymphoma.
Patients diagnosed with stage I-III small bowel lymphoma in 2004-2015 who underwent surgery were identified in the National Cancer Database. Two cohorts were created based on systemic chemotherapy treatment status. The primary outcome was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival.
2283 patients met inclusion criteria Of these patients, 826 patients (36%) underwent surgical resection alone, and 1457 patients (64%) underwent resection with systemic chemotherapy. Chemotherapy was associated with improved overall survival in unadjusted (5-year overall survival, 55% versus 70%) and adjusted analysis (HR 0.54, 95% CI 0.47-0.63, p < 0.001).
Patients with small bowel lymphoma have a low five-year overall survival after surgery. Chemotherapy is associated with improved survival, although one third of patients do not receive this therapy. Several other clinical factors are identified that are also associated with overall survival, including histology subtype, margin status, age, and medical comorbidities. This information can help with prognostication and potentially aid in treatment decision-making.
原发性小肠非霍奇金淋巴瘤是一种罕见疾病，占小肠恶性肿瘤的 2%。目前对于这些异质性肿瘤的最佳治疗方法的数据有限。我们旨在研究不同治疗方式与小肠淋巴瘤患者手术结果之间的关系。
在 2004 年至 2015 年间，国家癌症数据库中确定了诊断为 I-III 期小肠淋巴瘤并接受手术的患者。根据全身化疗治疗情况创建了两个队列。主要结果是总生存期。采用调整后的 Cox 比例风险模型评估治疗策略对生存的影响。
2283 名患者符合纳入标准，其中 826 名患者（36%）仅接受手术切除，1457 名患者（64%）接受手术切除联合全身化疗。未调整（5 年总生存率，55%比 70%）和调整分析（HR 0.54，95%CI 0.47-0.63，p<0.001）均显示化疗与总体生存改善相关。
小肠淋巴瘤患者手术后五年总生存率较低。尽管三分之一的患者未接受化疗，但化疗与生存改善相关。还确定了其他几个与总生存期相关的临床因素，包括组织学亚型、切缘状态、年龄和合并症。这些信息有助于预后判断，并可能有助于治疗决策。
