[Current status and progress of staging and efficacy evaluation of marginal zone lymphoma]

Marginal zone lymphoma (MZL) is characterized by high clinical heterogeneity, making individualized precision therapy highly contingent upon accurate staging and dynamic response assessment. This review systematically summarizes the current status and progress in the evaluation of splenic MZL (SMZL), mucosa-associated lymphoid tissue (MALT) lymphoma, and nodal MZL (NMZL). In terms of staging modalities, selection should be based on subtype-specific characteristics; notably, as a novel radiotracer, 68Ga-Pentixafor positron emission tomography/computed tomography (PET/CT) provides crucial complementary value for evaluating lesions with low ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) avidity. In terms of staging system, the modified Ann Arbor, Lugano classifications and MZL-specific designations (ⅠS, ⅡS) should be comprehensively applied. In terms of efficacy evaluation, the paradigm for response assessment is shifting from isolated morphological measurements toward a multidimensional model integrating functional imaging (Deauville score), molecular-level response monitoring [measurable residual disease (MRD) and circulating tumor DNA (ctDNA)], and patient-reported outcomes (PRO). Importantly, a sustained complete response at 24 months (CR24) has emerged as a critical surrogate endpoint for predicting long-term prognosis. Follow-up management necessitates risk stratification-based dynamic monitoring, with a focus on early warning of histological transformation. Ultimately, this review aims to provide a reference to further optimize the standardized clinical diagnosis, treatment and holistic management of MZL in China.