Diagnostic and therapeutic splenectomy for splenic lymphomas: analysis of the National Cancer Data Base

ABSTRACT

Objectives: To examine the use of splenectomy, chemotherapy, and subsequent overall survival (OS) in contemporary patients with splenic lymphomas.

Methods: We analyzed records of 6450 patients with various splenic lymphomas recorded in the National Cancer Data Base (2004–2013). Survival was compared using Mantel-Byer test to account for guarantee-time bias, stratified by age, sex, comorbidities, and lymphoma stage.

Results: Splenectomy rate was overall 58%, and varied from 49% in splenic marginal zone (SMZL) to 77% in follicular lymphoma (FL). It significantly decreased across all histologies over time (overall from 69% in 2004, to 44% in 2013). Thirty-day mortality after splenectomy was 4%. Chemotherapy use varied from 40% in FL to 76% in diffuse large B-cell lymphoma (DLBCL), but increased significantly only for SMZL and T-cell lymphomas over time. Overall, 57% of splenectomies were performed as diagnostic procedures, which was significantly less common in academic hospitals (p < 0.0001). Following a diagnostic splenectomy, chemotherapy was not administered to 29% of patients with DLBCL, 49% with mantle cell, and 42% with T-cell lymphomas. Median OS ranged from 12.4 years for FL to 1.0 year for T-cell lymphomas. We found no association between performance of splenectomy and OS across all histologies. Patients with DLBCL who did not receive chemotherapy after a diagnostic splenectomy had significantly worse OS (p = 0.001). The association between post-splenectomy chemotherapy and OS was not observed in FL or SMZL.

Conclusion: many splenic lymphomas may be treated without surgery, but a high proportion of diagnostic splenectomies indicates an ongoing need for less invasive diagnostic modalities.

KEYWORDS:

• Epidemiology
• splenectomy
• splenic marginal zone lymphoma
• follicular lymphoma
• mantle cell lymphoma
• diffuse large B-cell lymphoma

Acknowledgements

This study was presented in part at the 58th American Society of Hematology Annual Meeting & Exposition, 3–6 December 2016, San Diego, CA. This study used a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the investigators. AJO reports research funding for the institution from Genentech, TG Therapeutics, and Spectrum Pharmaceuticals, and consulting for Spectrum Pharmaceuticals.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Jaleh Fallah http://orcid.org/0000-0001-7365-2104

Adam J. Olszewski http://orcid.org/0000-0002-6472-6658

Additional information

Funding

This work was supported by the American Cancer Society under grant 28608-RSGI-15-211-01-CPHPS; and the National Institute of General Medical Sciences under grant U54GM115677.