Department of General Surgery, Shaanxi Provincial Cancer Hospital, Xi'an, China.
Department of Oncology, The First Hospital of Yulin, Yulin, China.
Cancer Med. 2021 Oct;10(20):7060-7070. doi: 10.1002/cam4.4238. Epub 2021 Sep 21.
Although primary splenic lymphoma (PSL) is rare, it ranks first among splenic primary malignant cancers, and the incidence of lymphoma of spleen has gradually increased in recent years. However, the efficacy of surgery for PSL has not been clinically verified by large sample data, which has affected the formulation of relevant guidelines.
To assess whether surgery can enhance the prognosis PSL patients.
Extracted the data of patients with PSL from The Surveillance, Epidemiology, and End Results (SEER) database, and divided the patients into surgery and non-surgery group. Kaplan-Meier curves and log-rank tests were used to compare the overall survival (OS) and cancer-specific survival (CSS). The propensity score matching (PSM) was used to match the data, then compared the OS and CSS again. The COX proportional hazard regression model was used for univariate and multivariate analysis. Finally, we performed subgroup analysis in different Ahmann stages.
A sum of 2207 patients with PSL were enrolled, of which 1062 (48.1%) patients received surgery, and 1145 (51.9%) patients did not undergo surgery. Overall, patients in the surgery group had better OS and CSS. After the propensity scores matching, surgery was not statistically significant in OS and CSS. In the subgroup analysis, surgery was a protective factor for the OS and CSS in Ahmann I/II. However, surgery was no statistical significance in OS and CSS in Ahmann III. In patients with Ahmann Ⅰ/Ⅱ SMZL, surgery was a protective factor for OS and CSS. In patients with Ahmann Ⅲ SMZL, surgery was also statistically significant of OS and CSS.
Surgery can significantly improve the prognosis of patients with Ahmann Ⅰ/Ⅱ primary splenic lymphoma, but there was no survival difference in the Ahmann Ⅲ patients with or without surgery. For patients with SMZL, surgery was effective for improving OS and CSS.
尽管原发性脾淋巴瘤（PSL）较为罕见，但它在脾脏原发性恶性肿瘤中排名第一，近年来脾脏淋巴瘤的发病率逐渐增高。然而，手术治疗 PSL 的疗效尚未得到大样本数据的临床验证，这影响了相关指南的制定。
评估手术是否能改善 PSL 患者的预后。
从监测、流行病学和最终结果（SEER）数据库中提取 PSL 患者的数据，并将患者分为手术组和非手术组。采用 Kaplan-Meier 曲线和对数秩检验比较总生存期（OS）和癌症特异性生存期（CSS）。采用倾向评分匹配（PSM）匹配数据后，再次比较 OS 和 CSS。采用 COX 比例风险回归模型进行单因素和多因素分析。最后，我们在不同的 Ahmann 分期进行了亚组分析。
共纳入 2207 例 PSL 患者，其中 1062 例（48.1%）患者接受了手术，1145 例（51.9%）患者未接受手术。总体而言，手术组患者的 OS 和 CSS 更好。在进行倾向评分匹配后，手术在 OS 和 CSS 方面无统计学意义。在亚组分析中，手术是 Ahmann I/II 期 OS 和 CSS 的保护因素。然而，在 Ahmann III 期，手术在 OS 和 CSS 方面无统计学意义。在 Ahmann Ⅰ/Ⅱ SMZL 患者中，手术是 OS 和 CSS 的保护因素。在 Ahmann Ⅲ SMZL 患者中，手术对 OS 和 CSS 也有统计学意义。
手术能显著改善 Ahmann Ⅰ/Ⅱ 期原发性脾淋巴瘤患者的预后，但 Ahmann Ⅲ 期患者手术与否的生存差异无统计学意义。对于 SMZL 患者，手术能有效提高 OS 和 CSS。
