The role of surgical intervention in primary colorectal lymphoma: A SEER population-based analysis

Abstract

BackgroundPrimary colorectal lymphoma (PCL) is a rare colorectal malignancy. The standard treatment and prognostic factors of PCL remain unexplored. Therefore, a large population-based study should be conducted to provide a detailed review of this disease.MethodsWe extracted the data of eligible patients with PCL registered in the SEER database from 1973 to 2011. All statistical analyses were performed using SPSS 19.0.ResultsA total of 2050 (61.3%) of the 3342 patients with PCL underwent surgical intervention, and 1292 (38.7%) patients received no surgical treatment. The median overall survival was 95 months, and patients receiving surgery exhibited significantly prolonged survival (adjusted HR =0.69, P <0.001). Young age, early tumor stage, and indolent lymphoma were independent predictors of improved survival. Further survival analyses demonstrated the potential benefit of surgery in patients with early tumor stage, right-sided lesions, or diffuse large B-cell PCL. Conversely, surgical intervention did not improve the survival of patients with advanced-stage, left-sided, or indolent PCL.ConclusionPCL is a rare tumor that can be effectively treated. Surgical intervention may play an important role in the treatment of PCL. Early tumor stage, a right-sided lesion, and diffuse large B-cell histological PCL seem to be the clinical characteristics of optimal surgical candidates.

Surgical management of primary colonic lymphoma: Big data for a rare problem

“…The older age and male predominance observed in our cohort are similar to that reported in multiple studies across diverse patient populations . Similarly, the preponderance of B‐cell lineage tumors, in particular, DLBCL, is comparable to other reported series of GI and colorectal lymphoma …”

“…In comparison to other large published series, our study reflects modern care patterns and focuses on nonmetastatic surgical patients. The largest study of PCL to date included 3342 patients collected from the Surveillance, Epidemiology, and End Results (SEER) database, and demonstrated improved survival among patients who underwent surgery . However, further survival analyses demonstrated a benefit from surgery only among early‐stage patients, patients with right‐sided tumors, and patients with DLBCL.…”

“…The outcomes of, and indications for, surgical resection in colorectal lymphoma remain unclear. Multi‐institutional studies indicate 48% to 61% of patients with PCL have surgery . Surgery provides a definitive diagnosis, palliates symptoms, may prevent tumor perforation on chemotherapy, provides local control for aggressive disease, and may be the definitive treatment for chemotherapy‐resistant indolent histologic subtypes.…”

“…Multi-institutional studies indicate 48% to 61% of patients with PCL have surgery. [3][4][5] Surgery provides a definitive diagnosis, palliates symptoms, may prevent tumor perforation on chemotherapy, provides local control for aggressive disease, and may be the definitive treatment for chemotherapy-resistant indolent histologic subtypes. However, surgery is morbid, does not treat systemic disease, and does not definitively improve survival.…”

Colorectal lymphoma in Mexico: clinico-pathological and survival analysis

“…Regarding the lymphoma subtypes, most of the reported PCLs were of B-cell lineage, ranging from 82% to 100%, where only the Asian series had an occurrence of T cell lymphomas (13,14). In a SEER-based analysis performed by Cai et al (12) in the U.S., they found a similar proportion of B-cell vs. T-cell lymphomas (53% and 47%, respectively), although they studied cases in adults and children; other series including children also demonstrated the occurrence of T cell lymphomas (13), a fact that appears to be rare in adults. Between the cell subtypes, the most frequent is DLBCL, ranging from 45% to 74% (10-13), and our data are according to this subtype.…”