Prognostic impact of cancer-directed surgery in primary pulmonary lymphoma: a population-based, propensity score-matched analysis.

[BACKGROUND] Primary pulmonary lymphoma (PPL) is a rare lymphoproliferative disorder with unclear optimal management strategies. The prognostic impact of cancer-directed surgery (CDS) remains controversial, with existing evidence limited to small institutional series yielding conflicting conclusions. This study aimed to evaluate the association between CDS and survival outcomes in patients with PPL using a large population-based cohort.

[METHODS] Patients diagnosed with PPL between 2000 and 2014 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was employed to minimize confounding. Overall survival (OS) and cancer-specific survival (CSS) were assessed using Kaplan-Meier analysis and multivariable Cox regression with corrected Akaike information criterion (AICc)-based model averaging.

[RESULTS] A total of 2,782 patients with PPL were identified, of whom 889 (32.0%) underwent CDS. After 1:1 PSM, 727 well-balanced pairs were generated. In the matched cohort, patients who underwent CDS demonstrated significantly superior CSS (P<0.001) and OS (P<0.001) compared with those who did not receive CDS. Multivariable Cox regression confirmed CDS as an independent favorable prognostic factor for both CSS (hazard ratio 0.63, 95% confidence interval: 0.51-0.77) and OS. Subgroup analyses revealed that CSS and OS benefits associated with CDS were most pronounced among patients aged 60 years or younger, females, married individuals, those with Ann Arbor stage I-II disease, and those who received radiotherapy. Among histologic subtypes, patients with mucosa-associated lymphoid tissue (MALT) lymphoma derived a particular CSS benefit from CDS.

[CONCLUSIONS] CDS was associated with improved survival in patients with PPL, particularly among younger patients with early-stage disease and MALT lymphoma. These findings support consideration of surgery for selected patients with resectable PPL, although prospective validation is needed.