What is the clinical evidence from this study?

Study design: Cohort. Population: Primary Pulmonary Lymphoma (PPL) (n=1500). Intervention: Primary Pulmonary Lymphoma. Primary outcome: Annual percentage change in incidence (APC 2.7%, 95% CI 2.0-3.4, p=<0.001).

February 25, 2022Open Access

Incidence, prognostic factors and clinical practice of Primary Pulmonary Lymphoma: A large population-based retrospective study

Q: What are the key findings of this study?

The incidence of primary pulmonary lymphoma steadily increased over the past four decades with an annual percentage change of 2.7%.

Key Result

The incidence of primary pulmonary lymphoma steadily increased over the past four decades with an annual percentage change of 2.7%.

Study Design

Type

Cohort (n=1,500)

Multicenter

Yes

Structured PICO

Population

1,500 patients with primary pulmonary lymphoma, median age 66 years, identified from the US SEER database between 2000 and 2015.

Outcome

Overall survival (OS) and disease-specific survival (DSS)hard clinical

The incidence of primary pulmonary lymphoma has steadily increased over the past four decades, and newly constructed nomograms can reliably predict patient survival based on key prognostic factors.

Main Result

Effect estimate: APC 2.7% (95% CI 2.0-3.4)

p-value: p=<0.001

Limitations

Retrospective study design subject to inherent biases
Evolving pathological diagnostic criteria over time may have affected enrollment
Potential inclusion of patients with secondary pulmonary involvement from an undiscovered primary site
Lack of detailed treatment data in the SEER database (e.g., surgical approach, radiation field/dosage, chemotherapy regimen)
Missing clinical variables that impact survival, such as B symptoms, serum LDH levels, and comorbidities
Wide time interval of diagnosis (1975-2018) means some early cases might have been missed due to inferior detection strategies

Abstract

Abstract Purpose: Primary pulmonary lymphoma(PPL) is a rare disease entity of pulmonary malignancies. The purpose of this study was to learn learn the incidence, treatment and survival of PPL. Methods: The incidence trend of PPL was investigated using Joinpoint regression software provided by National Cancer Institute. Cox regression analysis was performed to identify prognostic factors related to overall survival(OS) and disease-specific survival(DSS). The Kaplan-Meier method and log-rank test were used to evaluate OS and DSS. Results: A total of 1500 PPL patients were included in this study. The incidence of PPL was steadily increasing by annual percentage change(APC) of 2.7%(95%CI 2.0-3.4, P＜0.001). The median age was 66.0(19.0-99.0) years old along with more female(54.4%) patients than male. The most common subtype of PPL was marginal zone lymphoma of mucosa-associated lymphoid tissue(MALT)(41.3%) and diffuse large b-cell lymphoma(DLBCL)(29.7%), and the treatment regimens vary between these two subtype. Age, primary site, surgery, radiation, chemotherapy and laterality were identified as independent prognostic factors. Nomograms constructed for PPL-MALT and PPL-DLBCL to predict 1-, 5-, and 10-year OS and DSS. The area under curve (AUC) and calibration curves exhibit robust and accurate performance. Conclusions: Although rarely diagnosed, the incidence of PPL was steadily increasing in the past four decades. Nomograms for MALT and DLBCL in predicting 1-, 5-, 10-year OS and DSS were reliable. A diagram was drawn to describe PPL-MALT and PPL-DLBCL clinical practice.

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