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Primary Colorectal Lymphoma

Institutional Experience and Review of a National Database

Hangge, Patrick T., M.D.1; Calderon, Esteban, M.D.1; Habermann, Elizabeth B., Ph.D.2; Glasgow, Amy E., M.H.A.2; Mishra, Nitin, M.D.1

doi: 10.1097/DCR.0000000000001279
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BACKGROUND: Primary colorectal lymphoma is rare, representing 0.2% to 0.6% of all colorectal cancers. Because of its low incidence and histologic variety, no treatment guidelines exist.

OBJECTIVE: The purpose was to report the experience of primary colorectal lymphoma in an institutional and a national cohort.

DESIGN: This was a retrospective cohort study.

SETTINGS: The study was conducted with institutional data composed of 3 tertiary referral centers and national data.

PATIENTS: Patients with primary colorectal lymphoma were identified within the Mayo Clinic (1990–2016) and the Surveillance, Epidemiology, and End Results database (1990–2014).

MAIN OUTCOME MEASURES: Primary outcomes were overall and 5-year survival.

RESULTS: For the institutional cohort (N = 82), 5-year survival was 79.9%. Five-year survival was higher for rectal (88.4%) than for colon tumors (77.2%; p = 0.004). On multivariable analysis, age <50 years was associated with higher overall survival (p = 0.04). Left-sided colon masses and aggressive histological subtypes were associated with worse survival (0.04 and 0.03). No effect of treatment modality on survival was noted. For the national cohort (N = 2942), 5-year survival was 58.4%. Five-year survival for rectal tumors was 61.0% and 57.8% for colon tumors. On multivariable analysis, factors associated with improved survival were age <70 y, (p < 0.0001), female sex (p = 0.005), right-sided masses (p = 0.02), and diagnoses after 2000 compared with 1990–1999 (p < 0.0001). Aggressive pathology (p < 0.0001) and stage III or stage IV presentation compared with stage I (p = 0.02 and p < 0.0001) were associated with worse survival.

LIMITATIONS: The institutional cohort was limited by sample size to describe treatment effect on survival. A major limitation of the national cohort was the ability to describe treatment modalities other than surgery, including chemotherapy and/or no additional treatment.

CONCLUSIONS: Poorer survival was noted in elderly patients and in those with aggressive pathology. An overall survival advantage was seen in women in the national cohort. Currently, optimal strategies should follow a patient-centered multidisciplinary approach. See Video Abstract at http://links.lww.com/DCR/A807.

1 Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Phoenix, Arizona

2 Division of Health Care Research and Policy and Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota

Funding/Support: None reported.

Financial Disclosure: None reported.

E-poster presentation at the meeting of The American Society of Colon and Rectal Surgeons, Nashville, TN, May 19 to 23, 2018.

Correspondence: Nitin Mishra, M.D., Mayo Clinic, Division of Colon and Rectal Surgery, PX SP 03 GenSrg, 5777 E Mayo Blvd, Phoenix, AZ 85054. E-mail: Mishra.nitin@mayo.edu

© 2019 The American Society of Colon and Rectal Surgeons