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

LI Hui; LI Jiancheng; LIU Feng; WU Di; CHEN Chuanben; LI Jinluan

doi:10.11999/JEIT250874

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LI Hui, LI Jiancheng, LIU Feng, WU Di, CHEN Chuanben, LI Jinluan. A Novel Prognostic Model Establishment and Treatment Efficacy Analysis for Primary Pulmonary Non-Hodgkin’s Lymphoma[J]. Journal of Electronics & Information Technology. doi: 10.11999/JEIT250874

Citation:

LI Hui, LI Jiancheng, LIU Feng, WU Di, CHEN Chuanben, LI Jinluan. A Novel Prognostic Model Establishment and Treatment Efficacy Analysis for Primary Pulmonary Non-Hodgkin’s Lymphoma[J]. Journal of Electronics & Information Technology. doi: 10.11999/JEIT250874

Citation:

LI Hui, LI Jiancheng, LIU Feng, WU Di, CHEN Chuanben, LI Jinluan. A Novel Prognostic Model Establishment and Treatment Efficacy Analysis for Primary Pulmonary Non-Hodgkin’s Lymphoma[J]. Journal of Electronics & Information Technology. doi: 10.11999/JEIT250874

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

doi: 10.11999/JEIT250874 cstr: 32379.14.JEIT250874

1.
Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou 350014, China
2.
The First Affiliated Hospital of Fujian Medical University, Fuzhou 350009, China
3.
Fuzhou Pulmonary Hospital of Fujian, Fuzhou 350008, China

Funds: Fujian Research and Training Grants for Youth and Middle-aged Leaders in Healthcare (2022), The Natural Science Foundation of Fujian Province (2025J01221), Fujian Provincial Clinical Research Center for Cancer Radiotherapy and Immunotherapy (2020Y2012)

Received Date: 2025-09-04
Accepted Date: 2026-01-22
Rev Recd Date: 2026-01-21

Available Online: 2026-03-04

Abstract

Abstract

Objective At 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. Methods Clinical 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 Discussions A 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 (p<0.001; Hazard Ratio(HR), 1.078; 95% Confidence Interval(CI), 1.072$ \sim $1.084), Ann Arbor stage (p<0.001), sex (p<0.001; HR, 0.719; 95% CI, 0.624$ \sim $0.829), primary site (p=0.037), pathological type (p< 0.001), B symptoms (p= 0.012; HR, 0.944; 95% CI, 0.773$ \sim $0.997), surgery (p< 0.001; HR, 1.453; 95% CI, 1.221$ \sim $1.728), chemotherapy (p<0.001; HR, 0.742; 95% CI, 0.631$ \sim $0.872), and marital status (p<0.001). Based on these factors, a nomogram predicting 3-, 5-, and 10-year CSS was established. By integrating the nomogram with the IPI, a prognostic model for PPL was developed with a C-index of 0.932. Using defined risk parameters, a novel prognostic index for PPL was constructed. The risk parameters included age>60 years, Ann Arbor stage III/IV, serum Lactate DeHydrogenase (LDH) level>1 times the normal level, performance status score>2, number of extranodal sites>1, male sex, pathological type other than Mucosa-Associated Lymphoid Tissue (MALT) lymphoma, presence of B symptoms, and absence of cancer treatment. Risk stratification was defined as follows: low-risk group (0$ \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 (p<0.001). In the analysis of treatment efficacy, both the United States and Chinese datasets showed that chemotherapy significantly reduced CSS in patients with primary pulmonary MALT lymphoma (p<0.001). No significant difference was observed between surgery and radiotherapy in patients with either primary pulmonary MALT lymphoma or diffuse large B-cell lymphoma (p>0.05). Conclusions This 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.
- Primary Pulmonary Non-Hodgkin’s Lymphoma (PPNHL),
- Novel prognostic index,
- Treatment efficacy,
- Multi-center analysis,
- Prognostic model

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References

[1]	SIEGEL R L, MILLER K D, FUCHS H E, et al. Cancer statistics, 2022[J]. CA: A Cancer Journal for Clinicians, 2022, 72(1): 7–33. doi: 10.3322/caac.21708.
[2]	SMALL W. Perez and brady’s principles and practice of radiation oncology[J]. JAMA, 2009, 301(19): 2046–2051. doi: 10.1001/jama.2009.718.
[3]	GIZA A, DUMNICKA P, KALICIŃSKA E, et al. Retrospective analysis of primary pulmonary lymphoma cases from Polish Lymphoma Research Group centers reveals associations between initial symptoms and outcomes[J]. Scientific Reports, 2025, 15(1): 27883. doi: 10.1038/s41598-025-12469-7.
[4]	PDQ Pediatric Treatment Editorial Board. Childhood non-hodgkin lymphoma treatment (PDQ^®)-Health professional version[R]. Bethesda: National Cancer Institute, 2002.
[5]	SMYTH R, SLOAN J M, BURKS E, et al. Primary pulmonary marginal zone lymphoma: An unusual cause of pulmonary infiltrates[J]. Respirology Case Reports, 2021, 9(8): e00806. doi: 10.1002/rcr2.806.
[6]	DONG Congsong, XIA Peng, QIU Wenli, et al. Evaluation of CT features for differentiating consolidation pattern of pulmonary MALT lymphoma from pneumonic-type lung adenocarcinoma[J]. Frontiers in Oncology, 2023, 13: 1234291. doi: 10.3389/fonc.2023.1234291.
[7]	The International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin’s lymphoma[J]. The New England Journal of Medicine, 1993, 329(14): 987–994. doi: 10.1056/NEJM199309303291402.
[8]	HE Xiaoyu, HUANG Qian, LI Wenqiang, et al. Prognostic factors and predictive models for primary pulmonary diffuse large B-cell lymphoma: A population-based analysis[J]. Hematology, 2024, 29(1): 2420160. doi: 10.1080/16078454.2024.2420160.
[9]	THIEBLEMONT C, CASCIONE L, CONCONI A, et al. A MALT lymphoma prognostic index[J]. Blood, 2017, 130(12): 1409–1417. doi: 10.1182/blood-2017-03-771915.
[10]	KIM H D, CHO H, JEONG H, et al. A prognostic index for extranodal marginal-zone lymphoma based on the mucosa-associated lymphoid tissue International Prognostic Index and serum β2-microglobulin levels[J]. British Journal of Haematology, 2021, 193(2): 307–315. doi: 10.1111/bjh.17222.
[11]	SHEN Hui and ZHOU Yaodong. Clinical features and surgical treatment of primary pulmonary lymphoma: A retrospective study[J]. Frontiers in Oncology, 2022, 12: 779395. doi: 10.3389/fonc.2022.779395.
[12]	NING Ye, HE Haiyan, LI Qiuyuan, et al. The prognosis of patients with primary pulmonary mucosa-associated lymphoid tissue lymphoma: Treated with surgery or chemotherapy?[J]. European Journal of Cardio-Thoracic Surgery, 2024, 65(3): ezae064. doi: 10.1093/ejcts/ezae064.
[13]	VANDEN EYNDEN F, FADEL E, DE PERROT M, et al. Role of surgery in the treatment of primary pulmonary B-cell lymphoma[J]. The Annals of Thoracic Surgery, 2007, 83(1): 236–240. doi: 10.1016/j.athoracsur.2006.08.026.
[14]	ABRISQUETA P. New insights into first-line therapy in diffuse large B-cell lymphoma: Are we improving outcomes?[J]. Journal of Clinical Medicine, 2024, 13(7): 1929. doi: 10.3390/jcm13071929.
[15]	JELICIC J, JUUL-JENSEN K, BUKUMIRIC Z, et al. Prognostic indices in diffuse large B-cell lymphoma: A population-based comparison and validation study of multiple models[J]. Blood Cancer Journal, 2023, 13(1): 157. doi: 10.1038/s41408-023-00930-7.
[16]	CLAVIJO N D, AGUIRRE J C F, DEL PILAR AGUDELO LOPEZ C, et al. Aligning outcomes: DLBCL prognosis at a 4th Level University Hospital in Bogotá is comparable to high-income nations, identification of additional prognostic markers for overall survival and relapse[J]. Ecancermedicalscience, 2024, 18: 1717. doi: 10.3332/ecancer.2024.1717.
[17]	PENCINA M J and D'AGOSTINO R B. Overall C as a measure of discrimination in survival analysis: Model specific population value and confidence interval estimation[J]. Statistics in Medicine, 2004, 23(13): 2109–2123. doi: 10.1002/sim.1802.
[18]	KAMMULA A V, SCHÄFFER A A, RAJAGOPAL P S, et al. Outcome differences by sex in oncology clinical trials[J]. Nature Communications, 2024, 15(1): 2608. doi: 10.1038/s41467-024-46945-x.
[19]	KISERUD C E, SCHOVER L R, DAHL A A, et al. Do male lymphoma survivors have impaired sexual function?[J]. Journal of Clinical Oncology, 2009, 27(35): 6019–6026. doi: 10.1200/JCO.2009.23.2280.
[20]	SOLAL-CÉLIGNY P, ROY P, COLOMBAT P, et al. Follicular lymphoma international prognostic index[J]. Blood, 2004, 104(5): 1258–1265. doi: 10.1182/blood-2003-12-4434.
[21]	O'REILLY S E and CONNORS J M. Non-Hodgkin's lymphoma. I: Characterisation and treatment[J]. British Medical Journal, 1992, 304(6843): 1682–1686. doi: 10.1136/bmj.304.6843.1682.
[22]	RADERER M, KIESEWETTER B, and FERRERI A J M. Clinicopathologic characteristics and treatment of marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma)[J]. CA: A Cancer Journal for Clinicians, 2016, 66(2): 153–171. doi: 10.3322/caac.21330.
[23]	CADRANEL J, WISLEZ M, and ANTOINE M. Primary pulmonary lymphoma[J]. European Respiratory Journal, 2002, 20(3): 750–762. doi: 10.1183/09031936.02.00404102.
[24]	GRAHAM B B, MATHISEN D J, MARK E J, et al. Primary pulmonary lymphoma[J]. The Annals of Thoracic Surgery, 2005, 80(4): 1248–1253. doi: 10.1016/j.athoracsur.2005.04.014.
[25]	ZUCCA E and CAVALLI F. Extranodal lymphomas[J]. Annals of Oncology, 2000, 11(S3): 219–222. doi: 10.1093/annonc/11.suppl_3.219.
[26]	WANG Haotian, ZHANG Ying, LI Zhaoxia, et al. Characteristics, efficacy, and prognosis analysis of newly diagnosed marginal zone lymphoma[J]. Frontiers in Immunology, 2024, 15: 1466859. doi: 10.3389/fimmu.2024.1466859.
[27]	ZIEPERT M, HASENCLEVER D, KUHNT E, et al. Standard international prognostic index remains a valid predictor of outcome for patients with aggressive CD20⁺ B-cell lymphoma in the rituximab era[J]. Journal of Clinical Oncology, 2010, 28(14): 2373–2380. doi: 10.1200/JCO.2009.26.2493.
[28]	SEHN L H and GASCOYNE R D. Diffuse large B-cell lymphoma: Optimizing outcome in the context of clinical and biologic heterogeneity[J]. Blood, 2015, 125(1): 22–32. doi: 10.1182/blood-2014-05-577189.
[29]	MAZLOOM A, MEDEIROS L J, MCLAUGHLIN P W, et al. Marginal zone lymphomas: Factors that affect the final outcome[J]. Cancer, 2010, 116(18): 4291–4298. doi: 10.1002/cncr.25325.
[30]	PARRY-JONES N, MATUTES E, GRUSZKA-WESTWOOD A M, et al. Prognostic features of splenic lymphoma with villous lymphocytes: A report on 129 patients[J]. British Journal of Haematology, 2003, 120(5): 759–764. doi: 10.1046/j.1365-2141.2003.04165.x.
[31]	ZHOU Zheng, SEHN L H, RADEMAKER A W, et al. An enhanced International Prognostic Index (NCCN-IPI) for patients with diffuse large B-cell lymphoma treated in the rituximab era[J]. Blood, 2014, 123(6): 837–842. doi: 10.1182/blood-2013-09-524108.
[32]	ZELENETZ A D, GORDON L I, CHANG J E, et al. NCCN Guidelines® insights: B-cell lymphomas, version 5.2021[J]. Journal of the National Comprehensive Cancer Network, 2021, 19(11): 1218–1230. doi: 10.6004/jnccn.2021.0054.
[33]	TIAN Zhizhong, LIU Linxia, WU Lijuan, et al. Correction: Enhancement of vitamin B6 production driven by omics analysis combined with fermentation optimization[J]. Microbial Cell Factories, 2024, 23(1): 257. doi: 10.1186/s12934-024-02532-9.
[34]	PINOTTI G, ZUCCA E, ROGGERO E, et al. Clinical features, treatment and outcome in a series of 93 patients with low-grade gastric MALT lymphoma[J]. Leukemia & Lymphoma, 1997, 26(5/6): 527–537. doi: 10.3109/10428199709050889.
[35]	THIEBLEMONT C, DUMONTET C, BOUAFIA F, et al. Outcome in relation to treatment modalities in 48 patients with localized gastric MALT lymphoma: A retrospective study of patients treated during 1976-2001[J]. Leukemia & Lymphoma, 2003, 44(2): 257–262. doi: 10.1080/1042819021000035680.
[36]	LIAO Qiuling, YU Qilin, YU Cheng, et al. Pulmonary mucosa-associated lymphoid tissue lymphoma: Insights from a 15-year study at a single institution involving 14 clinical cases[J]. World Journal of Surgical Oncology, 2024, 22(1): 219. doi: 10.1186/s12957-024-03500-8.
[37]	ZUCCA E and BERTONI F. The spectrum of MALT lymphoma at different sites: Biological and therapeutic relevance[J]. Blood, 2016, 127(17): 2082–2092. doi: 10.1182/blood-2015-12-624304.
[38]	TSANG R W and GOSPODAROWICZ M K. Radiation therapy for localized low-grade non-Hodgkin's lymphomas[J]. Hematological Oncology, 2005, 23(1): 10–17. doi: 10.1002/hon.743.
[39]	WÖHRER S, TROCH M, STREUBEL B, et al. MALT lymphoma in patients with autoimmune diseases: A comparative analysis of characteristics and clinical course[J]. Leukemia, 2007, 21(8): 1812–1818. doi: 10.1038/sj.leu.2404782.
[40]	BORIE R, WISLEZ M, ANTOINE M, et al. Lymphoproliferative disorders of the lung[J]. Respiration, 2017, 94(2): 157–175. doi: 10.1159/000477740.
[41]	ARMSTRONG P, HAYDEN P, JEFFERS M, et al. Pulmonary mucosa-associated lymphoid tissue lymphoma treated with radiation therapy: A case report and review of the literature[J]. Case Reports in Oncology, 2023, 16(1): 1528–1535. doi: 10.1159/000534802.
[42]	SANGUEDOLCE F, ZANELLI M, ZIZZO M, et al. Primary pulmonary B-cell lymphoma: A review and update[J]. Cancers, 2021, 13(3): 415. doi: 10.3390/cancers13030415.
[43]	FERRARO P, TRASTEK V F, ADLAKHA H, et al. Primary non-Hodgkin's lymphoma of the lung[J]. The Annals of Thoracic Surgery, 2000, 69(4): 993–997. doi: 10.1016/s0003-4975(99)01535-0.
[44]	REZAZADEH A, SZABO A, KHURANA A, et al. Outcomes of limited stage primary bone diffuse large B-cell lymphoma in the rituximab era: A multicenter, retrospective study[J]. Haematologica, 2024, 109(5): 1439–1444. doi: 10.3324/haematol.2023.283210.
[45]	KIEŁBOWSKI K, KORDYKIEWICZ D, JESIONKA J, et al. A rare case of primary pulmonary diffuse large B-cell lymphoma transformed from marginal zone mucosa-associated lymphoid tissue lymphoma[J]. Medicina, 2024, 60(6): 840. doi: 10.3390/medicina60060840.