A Novel Prognostic Model Establishment and Treatment Efficacy Analysis for Primary Pulmonary Non-Hodgkin’s Lymphoma

ObjectiveAt present, few studies have examined Primary Pulmonary non-Hodgkin’s Lymphoma (PPL). Most available reports are single-center retrospective studies. Therefore, no widely accepted prognostic index or treatment strategy for PPL has been established. This study aims to develop and validate a novel prognostic index based on the International Prognostic Index (IPI) for PPL using data from the United States cancer population and Chinese multicenter cohorts. The study also compares the therapeutic effects of different treatment approaches to predict clinical prognosis and provide evidence to support treatment decision-making for PPL.MethodsClinical data from patients diagnosed with PPL were collected from two sources. The first source was the Surveillance, Epidemiology, and End Results (SEER) database of the United States, covering the period from 2000 to 2019. The second source included patients treated between 2010 and 2021 at three tertiary hospitals in China. Independent prognostic factors were identified using the Cox proportional hazards regression model. A nomogram was constructed to predict Cancer-Specific Survival (CSS). Model performance was evaluated using the Concordance index (C-index) and calibration curves. The nomogram was combined with the IPI to develop a novel prognostic index. Risk stratification was performed, and the 3-year Overall Survival (OS) rate was calculated for each risk group. The Inverse Probability of Treatment Weighting (IPTW) method was applied to reduce confounding factors. Survival analysis was conducted using Kaplan-Meier curves and the log-rank test.Results and DiscussionsA total of 4 313 cases from the SEER database and 107 cases from the Chinese multicenter cohort were included. Multivariate Cox regression analysis showed that independent prognostic factors for PPL included age (pppp=0.037), pathological type (pp= 0.012; HR, 0.944; 95% CI, 0.773$ \sim $0.997), surgery (ppp60 years, Ann Arbor stage III/IV, serum Lactate DeHydrogenase (LDH) level>1 times the normal level, performance status score>2, number of extranodal sites>1, male sex, pathological type other than Mucosa-Associated Lymphoid Tissue (MALT) lymphoma, presence of B symptoms, and absence of cancer treatment. Risk stratification was defined as follows: low-risk group (0$ \sim $2 risk factors), low-intermediate-risk group (3$ \sim $4 risk factors), high-intermediate-risk group (5 risk factors), and high-risk group (6$ \sim $9 risk factors). The corresponding 3-year OS rates were 96.97%, 82.61%, 50.00%, and 11.11%, respectively (ppp>0.05).ConclusionsThis study develops a novel prognostic index for PPL based on data from the United States cancer population and a Chinese multicenter cohort. The model includes age, disease stage, serum LDH level, performance status score, and number of extranodal sites. The index demonstrates strong predictive performance and accuracy. Risk stratification based on this index provides estimated 3-year OS rates for different risk groups. Treatment efficacy analysis indicates that chemotherapy may reduce CSS in patients with primary pulmonary MALT lymphoma. In addition, no significant difference is observed between surgery and radiotherapy in patients with primary pulmonary MALT lymphoma or diffuse large B-cell lymphoma.