Survival outcomes and treatment patterns in primary vertebral diffuse large B-cell lymphoma.

Primary vertebral diffuse large B-cell lymphoma (PV-DLBCL) is a rare manifestation of extranodal non-Hodgkin lymphoma that presents with nonspecific symptoms and poses significant diagnostic and treatment challenges. While chemotherapy, radiation, and surgery are frequently employed, their relative impacts on long-term survival remain unclear. Using the SEER database (2000–2021), we identified 584 adult patients with histologically confirmed PV-DLBCL. Demographic, tumor, and treatment characteristics were analyzed. Cox proportional hazards models were used to evaluate predictors of mortality, and Kaplan-Meier analysis was performed to estimate overall survival. The median overall survival (OS) was 115 months. The 1-, 2-, 5-, and 10-year OS rates were 74.9%, 70.2%, 61.9%, and 49.3%, respectively. Increasing age, distant tumor stage, and unmarried status (single, widowed, or divorced) were independently associated with higher mortality. Chemotherapy was associated with significantly improved survival across all time points. By contrast, neither radiotherapy nor surgery conferred a survival benefit after multivariable adjustment. Patients diagnosed more recently (2013–2021) demonstrated lower mortality. In this population-based study of PV-DLBCL, chemotherapy emerged as the strongest predictor of improved survival. The lack of independent survival benefit from surgery or radiation underscores the need to reevaluate their routine use. Additionally, the association between marital status and survival highlights the importance of psychosocial factors in patient care. These findings inform treatment planning and support ongoing efforts to optimize care in this rare spinal lymphoma subtype.