Clinical characteristics and treatment outcomes in 348 patients with ocular adnexal lymphoma

Objective This study systematically evaluated the clinicopathological characteristics, treatment strategies, and prognostic factors of ocular adnexal lymphoma (OAL) in a Western Chinese cohort to provide evidence supporting the development of management guidelines for Asian populations. Methods This study retrospectively analyzed 348 patients with pathologically confirmed OAL who underwent ophthalmic surgery at West China Hospital, Sichuan University, between 2010 and 2023. Clinical characteristics, imaging findings, histopathological features, treatment modalities, and follow-up data were collected. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards regression. Results A total of 348 patients were included (median age, 58 years; 59.2% male). The most common presenting symptoms were a periorbital mass (60.92%), eyelid edema (40.8%), and proptosis (31.61%). Mucosa-associated lymphoid tissue (MALT) lymphoma was the predominant pathological subtype (82.18%). The 5-year overall survival (OS) and progression-free survival (PFS) rates were 87.8% and 70.8%, respectively. Multivariate analysis identified advanced Lugano stage and aggressive histological subtype as independent predictors of poorer PFS and OS. Among the 179 patients with limited-stage MALT lymphoma, those who received postoperative radiotherapy achieved a significantly higher 5-year PFS than those managed with observation alone (90.8% vs. 54.1%, p < 0.001). Intraocular invasion was identified in two patients. Conclusion OAL is generally associated with a favorable prognosis, although outcomes vary considerably according to disease stage and pathological subtype. Comprehensive ophthalmic evaluation, accurate histopathological classification, and thorough systemic staging are critical for optimal management. In patients with limited-stage MALT lymphoma, postoperative radiotherapy is associated with a significant improvement in progression-free survival.