Comparison of the Effect of Chemoradiotherapy and Chemotherapy on the Survival of Patients with Primary Diffuse Large B-Cell Lymphoma of the Spine: A SEER-Based Study

The role of radiotherapy in primary spinal diffuse large B-cell lymphoma (PB-DLBCL) remains controversial. This study explored the effects of chemoradiotherapy and chemotherapy alone on the survival of patients with PB-DLBCL and established an instructive nomogram. Survival analysis using the Kaplan-Meier method and log-rank test was performed for patients diagnosed with PB-DLBCL from 1983 to 2016, identified in the Surveillance Epidemiology and End Results database. The Cox regression model was used to analyze the effects of each variable on the overall survival (OS) and construct a nomogram for predicting OS in patients. Overall, 873 patients with PB-DLBCL were included. The patients were divided into the 1983–2001 (227 [26%]) and 2002–2016 (646 [74%]) groups. The 5-and 10-year OS rates of patients with PB-DLBCL in the 2002–2016 group were 62.8% and 49.9%, respectively. The results of the multivariate Cox regression analysis in the 2002–2016 group showed that age, stage, marriage, and treatment strategy were independent prognostic factors. Kaplan-Meier analysis showed that the OS of patients who underwent chemoradiotherapy from 2002 to 2016 was significantly better than that of patients treated with chemotherapy alone. Further subgroup analysis of patients with different stages of DLBCL and at different ages showed that chemoradiotherapy had a better prognosis than chemotherapy alone in stages I–II and age >60 years, whereas the advantages of chemoradiotherapy were not reflected in stages III–IV and age <60 years. Chemoradiotherapy improves the OS of patients with PB-DLBCL who are aged >60 years or have stage I–II disease. The nomograms established in this study can help clinicians determine prognosis and select treatment strategies.