The Impact of Surgical Intervention on The Survival of Primary Head and Neck MALT Lymphoma

Background Primary head and neck mucosa-associated lymphoid tissue lymphoma (HN-MALT) is a rare B-cell lymphoma whose epidemiology, clinical features, and treatment strategies remain unclear. Methods We conducted a retrospective analysis of HN-MALT data from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021) and compared the incidence and mortality rates among age groups. Kaplan-Meier was used to determine the overall survival (OS) and lymphoma-specific survival (LSS). Prognostic factors were identified using univariate and multivariate Cox regression models. Results In a cohort of 2,517 patients, the annual incidence rate of HN-MALT in patients ≥ 60 years old was higher than that in those < 60 years old, with an increasing trend in overall mortality over time. Multivariable Cox analysis identified that male, age ≥ 60 years, being divorced/separated/widowed, and having a second malignant neoplasm (SMN) were associated with poorer OS and LSS. Additionally, not receiving radiotherapy was identified as a risk factor for poorer OS, whereas not undergoing surgical treatment was associated with decreased LSS. Notably, subgroup analyses demonstrated that the combination of surgery and radiotherapy consistently yielded superior survival outcomes across key patient strata. It significantly improved OS compared to radiotherapy alone in males, females, patients aged ≥ 60, and married patients, regardless of SMN status. Most strikingly, this combined modality led to a pronounced improvement in LSS, particularly among patients aged ≥ 60 (males: HR = 0.221; females: HR = 0.447) and those categorized by marital status (married: HR = 0.379; divorced/separated/widowed: HR = 0.338), as well as in patients with or without SMN. Kaplan-Meier analyses confirmed that surgery combined with radiotherapy improved OS and LSS compared to radiotherapy alone in certain subgroups of patients with HN-MALT. Conclusions HN-MALT has unique clinical and pathological characteristics; surgery combined with radiotherapy can improve OS and LSS.