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Patterns of treatment and their outcomes in primary breast lymphoma; a comprehensive population-based analysis

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Abstract

Background

Primary breast lymphoma (PBL) is managed differently among centers, using surgery, systemic therapy and/or radiation. With data derived from the National Cancer Database (NCDB), we aim to describe treatments utilized in the United States, estimate the overall survival (OS) of different therapeutic modalities and determine the role of systemic therapy in patients with PBL.

Methods

We conducted a retrospective cohort study using de-identified data from the NCDB. The NCDB provided records of 4616 patients diagnosed with PBL between 2004 and 2015. We excluded patients diagnosed with HIV, with no survival data, not treated in the reporting facility, without histologic confirmation, with stage III/ IV disease and for whom surgery, radiation, or systemic therapy was contraindicated. Both propensity score weighting and Cox models were used to obtain adjusted estimates. Based on histopathology, PBL was classified into indolent (I-PBL) and aggressive (A-PBL).

Results

In a sample size of 2063 PBL patients, the median age was 67 years (interquartile range (IQR): 57–78), and 97% were females. In 1027 patients with I-PBL, the median follow-up was 66 months (95% confidence interval (CI): 32.6–107.2) and 60% of patients had extranodal marginal zone subtype. Systemic therapy did not improve adjusted-OS (median: 154 vs. 143 months, P = 0.36) (Hazard ratio (HR): 0.86, 95% CI: 0.60–1.25, P = 0.42). The treatment arms associated with the highest adjusted 5-year OS were as follows: radiation (85%), surgery (79%), systemic & radiation (87%) and radiation & surgery (87%) (P = 0.9). In 1036 patients with A-PBL, the median follow-up was 67.4 months (95% CI: 35.9–105), and 87% of patients had diffuse large B-cell subtype. Patients with A-PBL who received systemic therapy had an improved adjusted-OS (median: 115 vs. 72 months, P < 0.01) (HR: 0.45, 95% CI: 0.38–0.53, P < 0.001). The treatment arms associated with the highest adjusted 5-year OS were: systemic (69%), systemic & radiation (77%), systemic & radiation & surgery (79%) and systemic & surgery (79%) (P = 0.4).

Conclusions

Systemic therapy used as first-line treatment is essential in A-PBL. Local therapy in the I-PBL using surgery and/or radiation is effective in long-term disease control. There is significant variation in front-line treatment modalities utilized in PBL across the US, many associated with similar outcomes.

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Data availability

Data was provided by the national cancer database (NCDB).

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Acknowledgements

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Funding

This study was unfunded.

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Author notes

  1. Moaath K. Mustafa Ali and Yazan Samhouri contributed equally to this manuscript.

Authors and Affiliations

  1. Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA

    Moaath K. Mustafa Ali, Jennie Y. Law & Seung Tae Lee

  2. Division of Hematology and Cellular Therapy, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA

    Yazan Samhouri, Cyrus Khan & John Lister

  3. Division of Radiation Oncology, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA

    Rodney Wegner

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  1. Moaath K. Mustafa Ali
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  2. Yazan Samhouri
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Contributions

All authors had full access to all the data and analysis in the study and take responsibility for the integrity of data and the accuracy of the data analysis. Concept and design: YS, MKMA. Acquisition, data analysis, and result interpretation: All authors. Drafting of the manuscript: all authors. Critical revision of the manuscript: all authors. Statistical analysis: MKMA. Administrative and technical support: JL, YS. Supervision: JL, YS.

Corresponding author

Correspondence to Moaath K. Mustafa Ali.

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Conflict of interests

All authors have no conflict of interest.

Ethical approval

This study used de-identified data and was considered exempt from human protection oversight by the institutional review board.

Transparency statement

Moaath Mustafa Ali MD, MPH affirms that the manuscript is an honest, accurate, and transparent account of the study being reported, that no important aspects of the study have been omitted, and any discrepancies the study as planned have been explained.

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Mustafa Ali, M.K., Samhouri, Y., Law, J.Y. et al. Patterns of treatment and their outcomes in primary breast lymphoma; a comprehensive population-based analysis. Breast Cancer 29, 1022–1031 (2022). https://doi.org/10.1007/s12282-022-01382-w

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  • DOI: https://doi.org/10.1007/s12282-022-01382-w

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