The effect of surgery on primary splenic lymphoma: A study based on SEER database

Establishment of Prognosis Nomogram for Primary Splenic Diffuse Large B Cell Lymphoma: A Study Based on SEER Database

Despite being the most common primary tumor of the spleen, in the past, few studies have predicted the prognosis of primary spleen diffuse large B cell lymphoma. This study aimed to establish a nomogram prediction model of overall survival in primary DLBCL of the spleen. We screened out 347 patients with primary splenic DLBCL from surveillance, epidemiology, and end results database. According to the Cox regression results (age, Ann Arbor Stage, splenectomy and chemotherapy was the independent risk factor for primary splenic DLBCL), the nomogram was constructed. We evaluated the predictive ability of nomogram with C-Index (training cohort: 0.719 [0.669-0.769]; validation cohort: 0.711 [0.641-0.781]) and 3-year/5-year receiver operating characteristic area under curve (3-year/5-year ROCAUC, training cohort: 0.731/0.742; validation cohort: 0.721/0.742). Calibratioin plot shows that our predicted values fluctuate around the actual value, indicating good agreement with nomogram. The decision curve analysis (DCA) results showed that our nomogram could benefit more than Ann Arbor Stage for predicts the prognosis of the primary splenic DLBCL. The Kaplan-Meier and landmark analysis showed that a great discrimination between high-risk group and low-risk group (P < 0.05) and indicating that our nomogram has the good ability to identify high-risk patients. In this study, a nomogram prediction model for primary spleen DLBCL was established, which has good ability of prediction and generalization. It can help clinicians carry out individualized treatment measures.

Prognostic nomogram for primary splenic lymphoma: a SEER database-based study

This study aimed to establish a nomogram model based on the clinicopathological factors affecting the prognosis of patients with primary splenic lymphoma (PSL) to predict the overall survival (OS) and cancer-specific survival (CSS) of patients. A total of 4074 patients diagnosed with PSL were included in this study. Among them, 4052 cases from the SEER (Surveillance, Epidemiology, and End Results) database were randomized into a training set and an internal validation set in a 7:3 ratio. Another 22 patients from the First Affiliated Hospital of Xi'an Jiaotong University were used as an external validation set. The prognostic factors affecting the OS and CSS of patients were analyzed using univariate and multivariate Cox regression models. Survival analysis was performed using Kaplan-Meier (KM) method and compared by Log-rank test. Then, a nomogram model was established to predict OS and CSS. Finally, the model was validated both internally and externally using the concordance index (C-index), receiver operating characteristic curve (ROC), and calibration curve to evaluate its predictive value, and the decision curve analysis (DCA) was conducted to assess its clinical utility. Our results showed that the model displayed a good prediction ability. In the training set, the OS rates at 1, 3, and 5 years were 85.9%, 75.8% and 70.1%, respectively, while the CSS rates at 1, 3, and 5 years were 91.9%, 86.2% and 82.3%, respectively. Predictors in the prediction model of OS included age, sex, marital status, Ann Arbor stage, histology, surgery, chemotherapy and year at diagnosis. On the other hand, predictors in the model of CSS included age, Ann Arbor stage, histology, chemotherapy, and year at diagnosis. Internal and external validation of the nomogram model showed that the C-index for predicting OS was 0.678 (0.662, 0.694) in the training set, 0.672 (0.648, 0.696) in the internal validation set, and 0.704 (0.565, 0.843) in the external validation set; the C-index for predicting CSS was 0.685 (0.661, 0.709) in the training set, 0.683 (0.650, 0.716) in the internal validation set, and 0.676 (0.488, 0.864) in the external validation set. The calibration curves for several groups showed good consistency, and DCA suggested its clinical usability. In conclusion, the nomogram constructed in this study has a good predictive value for the survival of patients with PSL, and can be a clinically applicable and practical prediction tool, facilitating rapid and accurate individualized predictions of the patient survival.

Comparison of survival outcomes of different treatment modalities for patients with primary splenic diffuse large B cell lymphoma

Primary splenic diffuse large B cell lymphoma (DLBCL) is one of the most common primary tumors in the spleen, while its prevalence is relatively low. Recently, there has been an increase in the incidence rate of primary splenic DLBCL; however, the effectiveness of various treatments for it has not been adequately described previously. The purpose of this study was to compare the effectiveness of various treatments on survival time in primary splenic DLBCL. A total of 347 patients with primary splenic DLBCL were enrolled in The Surveillance, Epidemiology, and End Results (SEER) database. These patients were subsequently divided into four subgroups according to the treatment modalities: non-treatment group (patients who had not received chemotherapy, radiotherapy, or splenectomy, n=19), splenectomy group (patients who had received splenectomy only, n=71), chemotherapy group (patients who had received chemotherapy only, n=95), and the splenectomy combined with chemotherapy group (patients who had received splenectomy and chemotherapy, n=162). The overall survival (OS) and cancer specific survival (CSS) of four treatment groups were evaluated. Compared to the splenectomy group and the non-treatment group, the OS and CSS of the splenectomy combined with chemotherapy group was extremely significantly prolonged (P<0.01). Compared with the chemotherapy group, the OS and CSS of the splenectomy combined with chemotherapy group were longer, but there was no statistical difference (P>0.05). The Cox regression analysis showed that the treatment modality was identified as an independent prognostic factor for primary splenic DLBCL. The landmark analysis shows that the overall cumulative mortality risk was significantly lower in the splenectomy combined with chemotherapy group than in the chemotherapy group within 30 months (P<0.05), and the cancer-specific mortality risk was significantly lower in the splenectomy combined with chemotherapy group than in the chemotherapy group within 19 months (P<0.05). Splenectomy combined with chemotherapy may be the most effective treatment modality for primary splenic DLBCL.

The effect of surgery on primary splenic lymphoma: A study based on SEER database

BACKGROUND

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.

AIM

To assess whether surgery can enhance the prognosis PSL patients.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.