[Current status and progress of prognostic evaluation in marginal zone lymphoma]

Marginal zone lymphoma (MZL) is an indolent B-cell non-Hodgkin lymphoma with marked heterogeneity. Currently, histological subtype, clinical stage, biochemical parameters, and clinical scoring systems represented by the MZL-international prognostic index (MZL-IPI) remain the principal basis for risk stratification; however, their differentiation power is limited, particularly for intermediate-risk groups, and they can not fully reflect the biological heterogeneity of the disease. Molecular genetic studies have revealed the significant prognostic impact of mutations in genes such as NOTCH2, KLF2, TNFAIP3, and TP53, as well as chromosomal abnormalities including t(11;18) and 7q deletion, with TP53 mutations being closely associated with histological transformation and high-risk outcomes. In the field of imaging, ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) has inherent limitations in MZL, whereas novel targeted tracers like C-X-C motif chemokine receptor type 4 (CXCR4) PET/CT show improved lesion detection rates and preliminary prognostic value, and imaging omics holds promise for non-invasively revealing tumor heterogeneity. This review systematically summarizes the current status and shortcomings of these prognostic factors, and proposes that future efforts should focus on integrating clinical, molecular genetics, imaging, and multi-omics data, and leveraging artificial intelligence technology to construct multicenter-validated, multidimensional prognostic models, so as to advance precision risk stratification and individualized treatment for MZL.