A population-based analysis of primary colonic lymphoma: Patterns of care and outcomes

Abstract

Background

Primary colorectal lymphoma is a rare malignancy (∼1%) with a rising incidence over the last 3 decades. Treatment is not standardized and includes combinations of chemotherapy, surgery, and radiation. The aim of this study was to describe patterns of care and outcomes of primary colorectal lymphoma in a US population-based cohort.

Methods

The Surveillance, Epidemiology, and End Results Database was queried to identify adults diagnosed with primary colorectal lymphoma, 2000–2015. Logistic regression and cox proportional hazard models estimated the effects of patient factors on treatment received, and survival, respectively.

Results

Of 1,721 patients (52% aged ≥65 years, 62% male, 80% White) 21% underwent chemotherapy alone, 31% surgery only, 22% surgery + chemotherapy, 8% radiation, and 18% no treatment. Multinomial analysis showed age, race, marital status, stage, histology, and lymphoma location were significantly associated with treatment received. No treatment was associated with older age. Proximal lesions more often underwent surgery + chemotherapy. After adjustment, factors associated with worse overall and disease-specific survival included age, sex, race, stage, and histology. No treatment was associated with lower overall survival when compared to chemotherapy, whereas surgery + chemotherapy had better prognosis.

Conclusion

In this population-based cohort, ∼20% of patients did not receive any treatment, which was associated with increasing age and worse survival. Patients with proximal lesions were more likely to undergo surgery + chemotherapy, with improved prognosis, possibly suggesting localized disease amenable to surgical resection and systemic treatment may lead to better oncologic outcomes, and elderly and Black individuals had worse survival rates, suggesting potential disparities extending to these subsets of patients.