Surgery first had better prognosis and safety compared to chemotherapy first in patients with primary intestinal lymphoma.

[OBJECTIVE] To investigate the efficacy and safety of patients with primary intestinal lymphoma (PIL) who received either surgery first or chemotherapy first, aiming to provide robust evidence for clinical treatment.

[METHODS] We collected the medical records of 82 patients with PIL from 2011 to 2020 for retrospective study. The patients was divided into two groups: the surgery first group (surgery followed by chemotherapy, SF group) and the chemotherapy first group (chemotherapy followed by surgery or without surgery, CF group).

[RESULTS] The 3-year OS and 5-year OS of patients in SF group were higher than that in CF group (P < 0.05). Subgroup analysis showed that it had higher 5-year OS and 3-year OS in patients who were <60 years old, stage I-II, International Prognostic Index (IPI) score ≤2 or lymphoma located in the large bowel treated with SF compared to CF (P < 0.05). Univariate analysis revealed that patients <60 years old, with an IPI score of 1-2 and who underwent SF had a higher 5-year OS (P < 0.05). COX regression analysis demonstrated that age was an independent prognostic factor for OS (P = 0.006). The incidence of perioperative complications was lower in SF group than that in CF group (2.86 % vs. 36.17, P < 0.001). Univariate analysis and Multivariate logistic regression analysis both identified intestinal obstruction as the sole independent risk factor for surgery in CF group (P = 0.002).

[CONCLUSION] The patients with PIL who received SF had better prognosis and greater perioperative safety than those who received CF.