Surgical management of stage IE/IIE primary pulmonary lymphomas: a propensity score matching study

Primary pulmonary lymphomas (PPLs) are rare malignancies that are frequently misdiagnosed due to their non-specific symptoms and ambiguous imaging findings. Although chemotherapy and radiation are typically the main treatment options, the role of surgery in managing PPLs remains uncertain. This study aimed to evaluate the impact of surgery on survival outcomes in patients with stage IE/IIE PPLs.

We analyzed 2,693 patients with stage IE/IIE PPLs using Cox regression and Kaplan-Meier analyses to assess overall survival (OS) and cancer-specific survival (CSS). Subgroup analyses were performed based on histological subtypes, including mucosa-associated lymphoid tissue (MALT) lymphoma, diffuse large B-cell lymphoma (DLBCL), other non-Hodgkin's lymphoma (NHL), and Hodgkin's lymphoma (HL). Additionally, we analyzed tumor stage and patient characteristics. Propensity score matching (PSM) was applied to reduce potential biases.

Among the patients, 1,013 underwent surgery, while 1,680 did not. After PSM, surgery was associated with significantly improved OS [hazard ratio (HR) =0.75, 95% confidence interval (CI): 0.66-0.86, P<0.001] and CSS (HR =0.66, 95% CI: 0.54-0.81, P<0.001). Notably, surgery significantly improved OS and CSS in patients with stage IE (OS: HR =0.62, 95% CI: 0.46-0.84, P=0.002; CSS: HR =0.57, 95% CI: 0.39-0.84, P=0.005) and stage IIE (OS: HR =0.64, 95% CI: 0.41-0.99, P=0.046; CSS: HR =0.47, 95% CI: 0.27-0.85, P=0.01) DLBCL. However, surgery did not significantly affect OS (P=0.24) or CSS (P=0.83) in patients with HL, stage IE/IIE MALT lymphoma (stage IE: OS, P=0.11; CSS, P=0.34; stage IIE: OS, P=0.40; CSS, P=0.75), or stage IE/IIE other NHL (stage IE: OS, P=0.050; CSS, P=0.46; stage IIE: OS, P=0.22; CSS, P=0.11). Additionally, sublobectomy demonstrated outcomes comparable to lobectomy/pneumonectomy in terms of OS and CSS for both stage IE (OS: HR =0.81, 95% CI: 0.63-1.06, P=0.13; CSS: HR =0.91, 95% CI: 0.58-1.43, P=0.70) and stage IIE (OS: HR =0.66, 95% CI: 0.40-1.09, P=0.10; CSS: HR =0.58, 95% CI: 0.26-1.29, P=0.18) PPLs.

Surgery improves oncological outcomes for patients with stage IE/IIE DLBCL but does not provide survival benefits for MALT lymphoma, other NHL, or HL. Sublobectomy may be a viable surgical option when complete resection is achieved.