Predictors of survival in gastric mucosa-associated lymphoid tissue lymphoma: An updated surveillance, epidemiology, and end results-based analysis of age and gender disparities

Abstract

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma is a subtype of extranodal marginal zone lymphoma, typically occurring in mucosal sites such as the stomach, salivary glands, and lungs. This study aims to analyze the demographic and clinicopathologic characteristics of patients with gastric MALT lymphoma in the United States and evaluate the interaction between age and gender on survival outcomes.

AIM

To analyze the demographic and clinicopathologic characteristics of patients with gastric MALT lymphoma in the United States and evaluate the interaction between age and gender on survival outcomes.

METHODS

A retrospective cohort study was conducted using the Surveillance, Epidemiology, and End Results (SEER) database, which included 2453 patients diagnosed with MALT lymphoma from 2010 to 2021. Data were analyzed for demographic factors, tumor characteristics, treatment modalities, and survival outcomes. A Cox proportional hazards regression model was used to identify predictors of overall mortality and cancer-specific mortality.

RESULTS

The study predominantly included Non-Hispanic White patients (62.78%), with nearly equal gender distribution (50.31% females, 49.69% males), and most diagnoses occurring in individuals aged 60-79 years. The majority of tumors were localized (80.07%). Multivariate analysis identified older age, male gender, advanced tumor stage, and socioeconomic factors—such as annual income and marital status—as independent predictors of mortality. No significant interaction between age and gender on mortality outcomes was observed.

CONCLUSION

Sociodemographic factors, including advanced age, male gender, annual income, and marital status, as well as advanced tumor stage, significantly impacted survival outcomes in patients with MALT lymphoma. Radiotherapy was associated with a reduction in overall mortality. Early detection is crucial for optimizing outcomes, as localized disease responds well to available treatment modalities.

Key Words: Mucosa-associated lymphoid tissue lymphoma; Extranodal marginal zone lymphoma; Mortality; Gastrointestinal cancer

Core Tip: Mucosa-associated lymphoid tissue (MALT) lymphomas are challenging to diagnose due to their varied organ involvement and diverse clinical presentation. Through our population-based analysis using the Surveillance, Epidemiology, and End Results database, we identified several sociodemographic factors that predicted survival in patients with gastric MALT lymphoma. Older age, male gender, advanced disease stage, annual income, and marital status were independent predictors of mortality. Radiotherapy reduced the risk of overall mortality by 22%. No interaction between age and male gender was observed in mortality outcomes. Further studies examining the effects of covariate interactions on survival are needed to better understand the pathophysiology of this malignancy and improve patient outcomes.

INTRODUCTION

Mucosa-associated lymphoid tissue (MALT) lymphoma is a distinct subtype of extranodal marginal zone lymphoma, characterized by its occurrence in various mucosal sites such as the stomach, salivary glands, and lungs. The demographics and clinicopathologic characteristics of patients with MALT lymphoma vary significantly across different populations. According to the data from the Surveillance, Epidemiology, and End Results (SEER) program, the majority of MALT lymphoma patients in the United States are Non-Hispanic White (62.78%), with nearly equal gender distribution (50.31% females and 49.69% males), and most diagnoses occurring in individuals aged 60-79 years[1-3].

The impact of demographic factors such as age and gender on the survival outcomes of MALT lymphoma patients has been an area of active research. Prior studies have demonstrated that older age is associated with poorer prognosis in lymphoma patients[4,5]. Gender also plays a crucial role in the prognosis of MALT lymphoma. This gender disparity in survival outcomes is corroborated by existing literature, which suggests that biological differences and potentially different responses to treatment may contribute to these variations[6-8].

However, to our knowledge, the interaction between age and gender on survival outcomes in patients with MALT lymphoma remains complex and has not yet been fully explored. This study aims to evaluate the extent to which age and gender interact to affect mortality.

MATERIALS AND METHODS

A retrospective cohort study of 2453 patients with gastric MALT lymphoma was carried out using the SEER database, which includes data from 17 registries and the November 2023 submission (http://www.seer.cancer.gov), accessed on 25 June 2024. The study comprised data on patients from the years 2010–2021. The SEER database is supported by the United States National Cancer Institute. The SEER Program, known for being one of the most comprehensive and credible cancer data sources in the United States, compiles the SEER 18 database. This database records cancer incidence, as well as clinical and pathological details of patients and survival outcomes from 18 population-based cancer registries, encompassing roughly 28% of the US population.

Data from the SEER database were retrieved using histological codes for the diagnosis of MALT/Extranodal marginal lymphoma along with the primary site code corresponding to the stomach. Patients with an unspecified age at diagnosis, race, or stage of MALT lymphoma were excluded from the study. Patients with secondary MALT lymphomas and those with other concurrent malignancies were also excluded. All variables used in the analysis were considered primary exposures.

Overall mortality (OM) refers to deaths from any cause by the end of this study period. Cancer-specific mortality (CSM) is defined as deaths resulting from complications associated with MALT lymphoma by the study’s conclusion. Variables extracted for the study included age at diagnosis, gender, race (White, Black, and others), ethnicity (non-Hispanic and Hispanic), stage at diagnosis (localized, regional, distant), residential geographic area, annual income, marital status, year of diagnosis, and treatment methods, such as surgery, radiation, and chemotherapy.

The Cox proportional hazards regression model presupposes that hazard rates stay consistent over time. In the analysis, variables showing a P value below 0.1 in the univariate Cox regression were selected for inclusion in the multivariate Cox proportional hazards model. This approach was used to identify independent predictors of OM and CSM, where a hazard ratio (HR) exceeding 1 indicates detrimental prognostic factors. All evaluations were two-tailed, employing a 95%CI, and findings with a P value under 0.01 were considered to be statistically significant. These statistical assessments were conducted using STATA 18 software.

RESULTS

Demographic and clinicopathologic characteristics of patients with MALT lymphoma

Table 1 presents a comprehensive overview of the demographic and clinicopathologic characteristics of US patients diagnosed with MALT lymphoma from 2010 to 2021. The majority of patients were Non-Hispanic White (62.78%), followed by Hispanic (14.64%) and Non-Hispanic Black (11.99%). Gender distribution was nearly equal, with females comprising 50.31% and males 49.69%. Most diagnoses occurred in patients aged 60-79 (52.43%), with a smaller percentage in the 40-59 age range (28.70%). A significant portion of patients were married (59.72%). The majority of tumors were localized (80.07%). Most patients resided in metropolitan areas with populations over 1 million (61.39%). In terms of income, the highest percentage of patients had an annual income between $60000 and $79999 (36.77%). Treatment primarily involved surgery (98.57%), with chemotherapy and radiation used less frequently (11.82% and 44.48%, respectively). Diagnoses were distributed relatively evenly across the years, with slight variations.

Table 1 Demographic and clinicopathologic characteristics of United States patients diagnosed with mucosa-associated lymphoid tissue lymphoma between 2010 and 2021.

Characteristics	n	%
Race
NH-White	1540	62.78
NH-Black	294	11.99
Hispanic	359	14.64
Other	260	10.60
Gender
Female	1234	50.31
Male	1219	49.69
Age at diagnosis (years)
0-39	105	4.28
40-59	704	28.70
60-79	1286	52.43
80+	358	14.59
Marital status
Married	1465	59.72
Single	441	17.98
Divorced/separated	241	9.82
Widowed	306	12.47
Tumor stage
Localized	1964	80.07
Regional	262	10.68
Distant	227	9.25
Living area
Counties in metropolitan areas of 1 million persons	1506	61.39
Counties in metropolitan areas of 250000 to 1 million persons	553	22.54
Counties in metropolitan areas of 250000 persons	173	7.05
Nonmetropolitan counties adjacent to a metropolitan area	118	4.81
Nonmetropolitan counties not adjacent to a metropolitan area	103	4.20
Income per year
< $40000	36	1.47
$40000-59999	320	13.05
$60000-79999	902	36.77
$80000-99999	730	29.76
$100000+	465	18.96
Radiation
No	1362	55.52
Yes	1091	44.48
Chemotherapy
No	2163	88.18
Yes	290	11.82
Surgery
No	35	1.43
Yes	2418	98.57
Year of diagnosis
2010	222	9.05
2011	185	7.54
2012	209	8.52
2013	198	8.07
2014	225	9.17
2015	218	8.89
2016	228	9.29
2017	202	8.23
2018	209	8.52
2019	179	7.30
2020	194	7.91
2021	184	7.50

Unadjusted analysis of variables associated with mortality in MALT lymphoma

Table 2 presents a crude analysis of factors associated with overall and cancer-related mortality among US patients diagnosed with MALT lymphoma from 2010 to 2021. For OM, males had a higher HR (HR = 1.30) compared to females. Older age groups, particularly those aged 80 and older, showed significantly higher mortality risks (HR = 8.04). Single, divorced/separated, and widowed patients also faced increased risks, with widowed individuals showing the highest HR (2.80). Advanced tumor stages, especially distant stages, were associated with increased mortality (HR = 1.78). Higher-income levels were associated with reduced mortality, with the highest income group ($100000+) having the lowest HR (0.43). Radiation therapy was linked to lower OM (HR = 0.69), while chemotherapy increased the risk (HR = 1.26). Cancer-related mortality exhibited similar trends for age and tumor stage, with the 80+ group (HR = 7.64) and distant stage tumors (HR = 5.25) showing significantly higher risks. Widowed patients and those receiving chemotherapy also faced higher cancer-related mortality, while radiation therapy was associated with reduced risk (HR = 0.54). Ethnicity and living area showed varied but generally non-significant associations, except for a lower cancer-related mortality in "Other" ethnic groups (HR = 0.65).

Table 2 Crude analysis of factors associated with all-cause mortality and cancer related mortality among United States patients diagnosed with mucosa-associated lymphoid tissue lymphoma between 2010 and 2021.

Characteristics	Overall mortality. Crude proportional. Hazard ratio (95%CI)	Cancer related mortality. Crude proportional. Hazard ratio (95%CI)
Race
NH-White	1 (reference)	1 (reference)
NH-Black	1.16 (0.90-1.50)	1.43 (0.85-2.40)
Hispanic	0.80 (0.61-1.05)	1.12 (0.66-1.91)
Other	0.65 (0.46-0.92)	1.62 (0.96-2.72)
Gender
Female	1 (reference)	1 (reference)
Male	1.30 (1.09-1.54)b	1.29 (0.90-1.85)
Age at diagnosis (years)
0-39	1 (reference)	1 (reference)
40-59	1.01 (0.50-2.02)	1.10 (0.25-4.80)
60-79	2.34 (1.21-4.55)a	2.55 (0.62-10.43)
80+	8.04 (4.12-15.71)b	7.64 (1.85-31.61)b
Marital status
Married	1 (reference)	1 (reference)
Single	1.39 (1.09-1.77)b	1.59 (1.00-2.52)
Divorced/separated	1.85 (1.41-2.43)b	1.43 (0.78-2.60)
Widowed	2.80 (2.26-3.49)b	2.03 (1.25-3.28)b
Tumor stage
Localized	1 (reference)	1 (reference)
Regional	1.07 (0.80-1.43)	2.29 (1.38-3.82)b
Distant	1.78 (1.38-2.29)b	5.25 (3.50-7.88)b
Living area
Counties in metropolitan areas of 1 million persons	1 (reference)	1 (reference)
Counties in metropolitan areas of 250000 to 1 million persons	1.17 (0.95-1.44)	0.86 (0.55-1.35)
Counties in metropolitan areas of 250000 persons	1.23 (0.89-1.70)	0.56 (0.23-1.38)
Nonmetropolitan counties adjacent to a metropolitan area	1.01 (0.68-1.53)	0.91 (0.40-2.09)
Nonmetropolitan counties not adjacent to a metropolitan area	1.10 (0.72-1.68)	0.71 (0.26-1.94)
Income per year
< $40000	1 (reference)	1 (reference)
$40000-59999	0.59 (0.34-1.02)	0.55 (0.16-1.88)
$60000-79999	0.51 (0.30-0.86)a	0.60 (0.19-1.93)
$80000-99999	0.46 (0.27-0.78)b	0.57 (0.18-1.87)
$100000+	0.43 (0.25-0.75)b	0.64 (0.19-2.14)
Radiation
No	1 (reference)	1 (reference)
Yes	0.69 (0.58-0.83)b	0.54 (0.37-0.79)b
Chemotherapy
No	1 (reference)	1 (reference)
Yes	1.26 (1.01-1.59)a	2.76 (1.87-4.08)b
Surgery
No	1 (reference)	1 (reference)
Yes	1.22 (0.61-2.46)	1.04 (0.26-4.22)

^aP < 0.05.

^bP < 0.01.

Multivariate analysis of factors associated with mortality in MALT lymphoma

The multivariate Cox proportional hazards regression analysis (Table 3) revealed several significant factors affecting all-cause and cancer-related mortality among United States patients with MALT lymphoma between 2010 and 2021. Males faced a higher risk of both overall (HR = 1.61) and cancer-related mortality (HR = 1.54). Older age significantly increased mortality, with those aged 80 and older showing the highest risks for both overall (HR = 9.23) and cancer-related mortality (HR = 12.53). Marital status influenced outcomes, with single individuals having higher risks for both overall (HR = 1.62) and cancer-related mortality (HR = 1.86). Advanced tumor stages were associated with increased mortality, particularly distant tumors, which greatly elevated both overall (HR = 1.78) and cancer-related mortality (HR = 4.74). Higher income levels were consistently associated with reduced OM. Radiation therapy was linked to reduced OM (HR = 0.78), while chemotherapy did not significantly affect mortality. Interestingly, the "Other" racial category had a significantly higher cancer-related mortality risk (HR = 2.18). These findings highlight the impact of demographic, clinical, and socioeconomic factors on survival outcomes in MALT lymphoma patients.

Table 3 Multivariate cox proportional hazard regression analyses of factors affecting all-cause mortality and cancer related mortality among United States patients diagnosed with mucosa-associated lymphoid tissue lymphoma between 2010 and 2021¹.

Characteristics	Overall Mortality. Adjusted proportional. Hazard ratio (95%CI)	Cancer related mortality. Adjusted proportional. Hazard ratio (95%CI)
Race
NH-White	1 (reference)	1 (reference)
NH-Black	1.28 (0.98-1.67)	1.54 (0.89-2.67)
Hispanic	0.94 (0.71-1.25)	1.13 (0.65-1.99)
Other	0.88 (0.62-1.26)	2.18 (1.24-3.83)b
Gender
Female	1 (reference)	1 (reference)
Male	1.61 (1.33-1.93)b	1.54 (1.04-2.27)a
Age at diagnosis (years)
0-39	1 (reference)	1 (reference)
40-59	1.18 (0.58-2.37)	1.31 (0.30-5.82)
60-79	2.75 (1.40-5.41)b	3.19 (0.76-13.39)
80+	9.23 (4.62-18.46)b	12.53 (2.88-54.51)b
Marital status
Married	1 (reference)	1 (reference)
Single	1.62 (1.25-2.08)b	1.86 (1.14-3.02)a
Divorced/separated	1.93 (1.46-2.55)b	1.60 (0.86-2.98)
Widowed	1.64 (1.28-2.11)b	1.16 (0.67-2.02)
Tumor stage
Localized	1 (reference)	1 (reference)
Regional	1.10 (0.82-1.47)	1.97 (1.16-3.36)a
Distant	1.78 (1.34-2.35)b	4.74 (2.93-7.68)b
Living area
Counties in metropolitan areas of 1 million persons	1 (reference)	1 (reference)
Counties in metropolitan areas of 250000 to 1 million persons	1.04 (0.84-1.30)	0.86 (0.54-1.39)
Counties in metropolitan areas of 250000 persons	0.99 (0.68-1.43)	0.56 (0.21-1.52)
Nonmetropolitan counties adjacent to a metropolitan area	0.72 (0.45-1.15)	0.85 (0.32-2.25)
Nonmetropolitan counties not adjacent to a metropolitan area	0.68 (0.40-1.15)	0.54 (0.16-1.90)
Income per year
< $40000	1 (reference)	1 (reference)
$40000-59999	0.35 (0.19-0.67)b	0.42 (0.10-1.78)
$60000-79999	0.29 (0.15-0.56)b	0.34 (0.08-1.49)
$80000-99999	0.27 (0.14-0.53)b	0.31 (0.07-1.42)
$100000+	0.23 (0.11-0.47)b	0.30 (0.06-1.42)
Radiation
No	1 (reference)	1 (reference)
Yes	0.78 (0.64-0.94)b	0.78 (0.52-1.17)
Chemotherapy
No	1 (reference)	1 (reference)
Yes	0.99 (0.76-1.29)	1.47 (0.91-2.39)
Surgery
No	1 (reference)	1 (reference)
Yes	1.10 (0.54-2.23)	0.75 (0.18-3.13)

^aP < 0.05.

^bP < 0.01.

¹Variables included in the multivariate model were age at diagnosis, gender, annual income, marital status, tumor stage, radiation, and chemotherapy.

Interaction between age and gender on mortality in patients with MALT lymphoma

The results in Table 4 highlight the influence of age on all-cause mortality (OM) and MALT lymphoma-related mortality (CSM) among male patients, focusing on the non-statistically significant p-values. For younger males aged 0-39, the HRs for both all-cause mortality (HR = 0.44) and CSM (HR = 0.56) were low and not statistically significant, indicating minimal risk in this age group. As age increased, the HRs for OM and CSM rose substantially. In the 40-59 age group, the HR for all-cause mortality was 3.05, and for CSM, it was 1.51, though neither reached statistical significance. The 60-79 age group showed a statistically higher risk for both OM (HR = 3.92) and CSM (HR = 2.88). The 80+ age group had HRs of 3.73 for OM and 3.54 for CSM, both of which were statistically insignificant. These findings suggest a clear trend of increasing mortality risk with age, though the lack of statistical significance warrants cautious interpretation and consideration of additional variables that might influence these outcomes. Our study found no interaction between age and gender regarding survival outcomes in MALT lymphoma patients.

Table 4 Multivariate cox proportional hazard regression analyses of factors affecting all-cause mortality and mucosa-associated lymphoid tissue lymphoma related mortality among United States patients between 2010 and 2021 taking into account the interaction between age category and gender.

Age category (Gender)	OM, hazard ratio (95%CI)	CSM, hazard ratio (95%CI)
00-39 (male)	0.44 (0.11-1.79)	0.56 (0.04-9.15)
40-59 (male)	3.05 (0.70-13.26)	1.51 (0.78-29.19)
60-79 (male)	3.92 (0.95-16.11)	2.88 (1.69-49.14)
80+ (male)	3.73 (0.89-15.56)	3.54 (1.99-62.68)

CSM: Cancer-specific mortality; OM: Overall mortality.

DISCUSSION

Our study revealed that the majority of patients in the United States who were diagnosed with MALT lymphoma between 2010 to 2021 were Non-Hispanic White (62.78%) and aged between 60-79 years. Of all patients, 50.31% were females and 49.69% were males. Multivariate analysis identified several significant predictors of mortality. Males had a 61% higher risk for all-cause and a 54% increased risk for cancer-related mortality. Patients aged 60 to 79 years had increased risk of OM [HR = 2.75 (1.40-5.41); P < 0.01] compared to younger age groups. Although the risk for CSM was also higher in this subgroup, the difference did not reach the level of statistical significance in the multivariate model. Patients aged 80 years and above had the highest risk of overall [HR = 9.23 (4.62-18.46); P < 0.01] and cancer-specific [HR = 12.53 (2.88-54.51); P < 0.01] mortality compared to other groups. This is consistent with prior literature, which identifies older age and male gender as independent predictors of mortality in lymphoma patients[4]. Notably, there was no interaction between age and gender with regard to survival outcomes.

The majority of patients were Non-Hispanic White (62.78%), followed by Hispanic (14.64%) and Non-Hispanic Black (11.99%). This distribution aligns with other studies showing a higher prevalence of MALT lymphoma in Western populations. Previous studies have demonstrated that MALT lymphoma is more common in Caucasians compared to other racial groups[4]. The nearly equal gender distribution observed (50.31% females and 49.69% males) is consistent with findings from other cohorts, where no gender predilection has been noted[5,6]. Age distribution data revealed that most diagnoses occurred in patients aged 60-79 (52.43%), which is consistent with literature indicating that this malignancy primarily affects older adults. Several studies have highlighted an increased incidence of MALT lymphoma in the sixth and seventh decades of life[1,5]. Furthermore, the significant proportion of married patients (59.72%) and the predominance of localized tumors (80.07%) suggest early-stage detection and favorable prognostic factors among patients with MALT lymphoma[7].

The majority of patients in our study had an annual income between $60000 and $79999 (36.77%), and most of them resided in metropolitan areas with populations over 1 million (61.39%). Patients with an annual income exceeding 40000 USD had a statistically lower risk of OM. Socioeconomic factors have a significant impact on healthcare access and outcomes in cancer patients. Lower socioeconomic status has been linked with limited access to cancer screening and treatment modalities, which subsequently results in increased cancer-related morbidity and mortality. These findings are consistent with broader trends observed in oncology, where socioeconomic status significantly impacts disease management and patient outcomes[9,10].

Several studies have highlighted the presence of racial differences in cancer associated outcomes[10]. Historically, black and Hispanic cancer patients have higher mortality compared to white patients. Our study, however, didn’t show any significant differences in survival among NH White, NH Black, and Hispanic patients. But patients of other ethnicities did have an elevated risk of cancer-related mortality [HR = 2.18 (1.24-3.83); P < 0.01] compared to others. This could be explained by barriers to healthcare access in this subset of patients, which result in delayed diagnoses, a greater incidence of complications and consequently lower event-free survival rates.

Marital status also had a remarkable impact on survival in our study population. Unmarried patients had a 62% increased risk of overall [HR = 1.62 (1.25-2.08); P < 0.01] mortality and an 86% increased risk of cancer-related [HR = 1.86 (1.14-3.02); P < 0.05] mortality. Widowed and divorced/separated patients had a 64% and 93% increased risk of OM, respectively, compared to married patients. Several studies have shown that marital status is an independent predictor of survival in cancer patients. Unmarried patients are more likely to have delayed diagnosis, metastatic disease on presentation, and increased rates of undertreatment and mortality[11-15]. Widowed and unmarried females are especially at high risk for cancer-related mortality and morbidity due to lack of adequate emotional and financial support[16-20]. These findings are relevant from a public health standpoint as they reaffirm the prior evidence on the impact of spousal or caregiver support on mortality in cancer patients.

The advent of Helicobacter pylori (H. pylori) eradication therapy has changed the treatment landscape of MALT lymphomas. Eradication therapy should be selected carefully because it can guarantee complete response in most cases. Patients who fail to respond or those without H. pylori infection benefit from alternative regimens involving radiation, chemotherapy and/or rituximab immunotherapy[21-23]. Interestingly, our study demonstrated that 98.57% of patients underwent surgery, whereas radiotherapy and chemotherapy were used for 44.5% and 11.8% of patients, respectively. These findings are at odds with contemporary literature which recommends use of surgical modalities either as a last resort after failure of alternative therapies or in complicated cases involving extensive hemorrhage, pyloric stenosis or perforation[22]. The high surgery rate may be attributed to a semantic discrepancy within the database which mistakenly classifies all endoscopic procedures performed for diagnostic evaluation and management of MALT lymphomas as surgical interventions with a therapeutic intent. Due to lack of granularity regarding this aspect, it is challenging to ascertain what proportion of these endoscopic interventions were performed solely for curative purposes.

Distant metastases were strongly predictive of increased OM [HR = 1.78 (1.34-2.35); P < 0.01] and cancer-related mortality [4.74 (2.93-7.68); P < 0.01]. This underscores the importance of early detection and treatment in optimizing outcomes[23,24]. Radiation therapy reduced the risk of OM by 22% [HR = 0.78 (0.64-0.94); P < 0.01]. Chemotherapy did not significantly affect mortality in our cohort. This could be due to the presence of advanced disease in patients undergoing chemotherapy, as H. pylori eradication therapy is the first-line treatment, followed by radiation for localized disease. Moreover, only 12% of patients received chemotherapy, compared to 44.5% who underwent radiotherapy.

Our analysis of United States patients diagnosed with MALT lymphoma from 2010 to 2021 provides valuable insights and has several strengths, including a large sample size of 2453 patients and the use of a robust statistical model to derive conclusions from population-based data in the SEER database. We identified several factors that independently predict mortality in patients with MALT lymphoma.

Our study has several limitations, including its retrospective design and potential selection bias, as the database lacks information on all relevant variables and our analysis is based solely on previously recorded data. We were unable to incorporate variables such as tumor size, H. pylori infection status, concomitant comorbidities, and the efficacy of various chemotherapy regimens for MALT lymphoma in our analytic model, as the SEER database lacks sufficient granularity for these variables. Moreover, our analysis is limited by the potential for unmeasured confounding variables.

CONCLUSION

Older age, male gender, advanced tumor stage, and socioeconomic factors, such as annual income and marital status, were independent predictors of survival in MALT lymphoma patients. No interaction between age and gender was observed with regard to mortality outcomes. Early detection is paramount as a large proportion of tumors are localized, and therefore, responsive to H. pylori eradication therapy and radiotherapy.