Clinical features and treatment outcomes in primary central nervous system lymphoma: a descriptive analysis of 62 patients
10.3760/cma.j.issn.0529-5807.2019.11.006
- VernacularTitle: 原发性中枢神经系统淋巴瘤62例临床病理学特征及预后
- Author:
Yan GE
1
;
Xingtao LIN
;
Donglan LUO
;
Fen ZHANG
;
Jie XU
;
Zhi LI
;
Yanhui LIU
Author Information
1. Department of Pathology, Guangdong Provincial People′s Hospital/Guangdong Academy of Medical Sciences, Guangzhou 510000, China
- Publication Type:Journal Article
- Keywords:
Central nervous system neoplasms;
Lymphoma, B-cell;
Lymphoma, large B-cell, diffuse;
Prognosis
- From:
Chinese Journal of Pathology
2019;48(11):861-866
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess clinical features and treatment outcomes in immunocompetent patients with primary central nervous system lymphoma (PCNSL).
Methods:Sixty-two patients with PCNSL who attended Guangdong General Hospital between January 1998 and January 2012 were included. Survival curves were estimated using Kaplan-Meier survival methodology and statistical significance of continuous was assessed via the Cox proportional hazard model.
Results:The median age of the patient cohort was 56 years, and the male to female ratio was 1.14∶1.00. The common presentations were increased intracranial pressure symptoms and neuron damage. Performance status of 54 (54/62, 87.1%) patients were the international prognostic index (IPI) 0-2. Diffuse large B-cell lymphoma (57/62, 91.9%) was most common, and the rest were T-cell lymphoma (4/62,6.4%) and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (1/62, 1.6%). In the series, 32 patients (32/62, 51.6%) had multiple lesions. Involvement of deep structures was found in 30 (30/62, 48.4%) patients. An elevated serum LDH level was detected in 19 (19/62, 30.6%) patients and the Ki-67 index was ≥90% in 38 (38/62, 61.3%) patients. Univariate analysis showed patients who were female, age<60 years, had WHO Eastern Cooperative Oncology Group performance status grade 0-2, single lesion, absence of deep structures involvement and normal LDH level showed better 2-year survival rate and longer median survival time. Significance was only seen in the normal LDH level group. Multivariate Cox regression analysis revealed that radical surgery only and Rituximab+ high-dose of methotrexate+ whole brain radiation therapy (WBRT) were independent prognostic indicators in PCNSL patients (P<0.05).
Conclusions:PCNSL is a rare but aggressive tumor with poor prognosis. Patients treated with high-dose of methotrexate combining with rituximab, followed by WBRT have a better prognosis and longer survival time, and thus these could probably be a promising treatment.
