Abstract
To compare survival outcomes among different initial treatment strategies for early-stage (stage I-II) breast mucosa-associated lymphoid tissue (MALT) lymphoma. Using data from the Surveillance, Epidemiology, and End Results program, we analyzed patients diagnosed with early-stage breast MALT lymphoma between 2000 and 2017. Statistical analyses included chi-square tests, Kaplan-Meier survival estimates, and multivariate Cox proportional-hazards models. Among 396 eligible patients, treatment strategies included surgery with or without postoperative radiotherapy (161 patients, 40.7%), radiotherapy alone (122 patients, 30.8%), and observation (113 patients, 28.5%). Temporal trends indicated increasing use of radiotherapy alone, while surgery alone and observation declined (P = 0.061). With a median follow-up of 94 months, the 8-year cancer-specific survival (CSS) and overall survival (OS) rates were 88.7% and 71.9%, respectively. Patients receiving local treatment (surgery and/or radiotherapy) alone demonstrated superior CSS (P = 0.002) and OS (P < 0.001) compared to observation. However, adding chemotherapy to local treatment was associated with worse CSS (P = 0.017) and OS (P = 0.003). Sensitivity analysis revealed no significant differences in CSS or OS among local treatment modalities (surgery alone, radiotherapy alone, or combined surgery and radiotherapy). Radiotherapy alone can achieve the optimal disease control for early-stage breast MALT lymphoma. The role of surgery is rather limited and is mainly considered when there is a diagnostic dilemma.