Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases.
BACKGROUND
There is a paucity of data regarding prognosis of primary thyroid lymphoma (PTL), with only case reports and institutional series reported. This is the first population-based study of PTL in the United States.


METHODS
PTL patients were identified in the SEER database. Bivariate (chi(2), Kaplan-Meier, and log rank) and multivariate (Cox proportional hazards) analyses were used to assess the associations between patient characteristics and survival.


RESULTS
A total of 1,408 patients were identified over 32 years of follow-up (median, 3.75 years). Mean age was 66 years; 75% were female and 93% white. Overall, 98% had non-Hodgkin's lymphoma; 68% had diffuse large B-cell, 10% follicular, 10% marginal zone, and 3% small lymphocytic. A total of 88% had stage I-II disease. Median survival was 9.3 years. On bivariate analysis, older age, single marital status, stage II-IV disease, histology (large B-cell, follicular, or other non-Hodgkin's), earlier year of diagnosis, lack of prior malignancies, and no radiation/surgery predicted worse survival. Age >or=80 years, advanced stage, no radiation/surgery, and large B-cell or follicular histology predicted worse prognosis in multivariate analysis.


CONCLUSIONS
Older age, advanced stage, histologic subtype, and lack of radiation/surgical treatment are associated with worse survival. Thyroid resection offers benefit only for patients with stage I disease. Management of PTL requires multidisciplinary collaboration.
Graff-Baker
Amanda
A
Department of Surgery, Yale University School of Medicine, New Haven, CT 06520, USA.
Roman
Sanziana A
SA
Thomas
Daniel C
DC
Udelsman
Robert
R
Sosa
Julie Ann
JA
D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008223:Lymphoma / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D018442:Lymphoma, B-Cell, Marginal Zone / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008224:Lymphoma, Follicular / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008228:Lymphoma, Non-Hodgkin / Q000453:epidemiology / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D014481:United States / Q000453:epidemiology