The Role of Surgery in the Management of Intestinal Diffuse Large B-Cell Lymphoma (DLBCL): A Propensity Score-Matched
Kefan Dai1,2,3, Yue Li1,2, Di Fu4
1Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The role of surgery in the management of intestinal diffuse large B-cell lymphoma (DLBCL) remains controversial. The study aimed to investigate the efficacy of surgery and explore the prognostic factors for patients with intestinal DLBCL.
Method:
A total of 118 patients diagnosed with intestinal DLBCL who received systemic therapy from 2011 to 2020 were retrospectively enrolled. Patients were divided into the conservative treatment group and the surgical treatment group based on whether they underwent surgical intervention prior to systemic therapy. Propensity score matching (PSM) analysis was utilized to control the confounding factors. Survival and Cox regression analyses were performed to evaluate the long-term outcome and prognostic risk factors.
Results:
Patients in the surgical treatment group had significantly higher progression-free survival (PFS) rates than patients who received conservative treatment (3-year PFS: 84.6% vs. 35.9%, p<0.001; 5-year PFS: 53.8% vs. 28.2%, p=0.021). The overall survival (OS) rates of the surgery group were also significantly higher than those of the conservative treatment group (3-year OS: 87.2% vs. 43.6%, p<0.001; 5-year OS: 56.4% vs. 30.8%, p=0.022). Surgical treatment was associated with a higher complete response rate and a lower disease progression/relapse rate (complete response rate: 87.2% vs. 53.8%, p=0.001; progression/relapse rate: 10.3% vs. 28.2%, p=0.044). Multivariate Cox regression analysis indicated that serum lactate dehydrogenase level and surgical intervention were independent prognostic factors for both PFS and OS, whereas bone marrow involvement was an independent prognostic factor for PFS.
Conclusion:
Combined surgical treatment manifested a better survival outcome than conservative treatment for patients with intestinal DLBCL. Serum lactate dehydrogenase level, bone marrow involvement, and surgical intervention are independent prognostic factors for survival.
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