The effect of surgery on primary splenic lymphoma: A study based on SEER database

Background Although primary splenic lymphoma (PSL) is rare, it ranks first among splenic primary malignant cancers, and the incidence of lymphoma of spleen has gradually increased in recent years. However, the efficacy of surgery for PSL has not been clinically verified by large sample data, which has affected the formulation of relevant guidelines. Aim To assess whether surgery can enhance the prognosis PSL patients. Methods Extracted the data of patients with PSL from The Surveillance, Epidemiology, and End Results (SEER) database, and divided the patients into surgery and non-surgery group. Kaplan-Meier curves and log-rank tests were used to compare the overall survival (OS) and cancer-specific survival (CSS). The propensity score matching (PSM) was used to match the data, then compared the OS and CSS again. The COX proportional hazard regression model was used for univariate and multivariate analysis. Finally, we performed subgroup analysis in different Ahmann stages. Results A sum of 2207 patients with PSL were enrolled, of which 1062 (48.1%) patients received surgery, and 1145 (51.9%) patients did not undergo surgery. Overall, patients in the surgery group had better OS and CSS. After the propensity scores matching, surgery was not statistically significant in OS and CSS. In the subgroup analysis, surgery was a protective factor for the OS and CSS in Ahmann I/II. However, surgery was no statistical significance in OS and CSS in Ahmann III. In patients with Ahmann I/II SMZL, surgery was a protective factor for OS and CSS. In patients with Ahmann III SMZL, surgery was also statistically significant of OS and CSS. Conclusions Surgery can significantly improve the prognosis of patients with Ahmann I/II primary splenic lymphoma, but there was no survival difference in the Ahmann III patients with or without surgery. For patients with SMZL, surgery was effective for improving OS and CSS.