Analysis on prognostic factors of primary central nervous system lymphoma

doi:10.19854/j.cnki.1008-2425.2022.04.0002

Abstract

Abstract: Objective To explore the prognostic factors of primary central nervous system lymphoma.Methods Clinical data of 66 patients with primary central nervous system lymphoma were collected,including gender,age,number of lesions,lesion location,pathological markers,pathological types,treatment methods,KPS scores before and after chemotherapy,etc.All patients were followed up,and univariate analysis and multivariate COX regression model analysis were used to analyze the factors affecting the prognosis of primary central nervous system lymphomapatients.Results Univariate analysis of all patients showed that there were no significant differences in 2-year overall survival rate and 1-year progression-free survival rate among primary central nervous system lymphoma patients with different gender,age,number of lesions,whether they had deep lesions,Ki-67 proliferation index and whether they originated from germinal center (P＞0.05); the 2-year overall survival rate and 1-year progression-free survival rate in patients with chemotherapy alone or chemotherapy combined with other treatments were significantly higher than those without chemotherapy (P＜0.05); patients whose KPS scores increased by more than 10 points before and after the first two chemotherapy were judged to be sensitive to chemotherapy,and the 2-year overall survival rate and 1-year progression-free survival rate were higher than those in patients insensitive to chemotherapy (P＜0.05).Univariate analysis of patients with certain outcomes showed that overall survival and progression-free survival were significantly longer in patients sensitive to chemotherapy than those in patients insensitive to chemotherapy.COX multivariate analysis showed that sensitivity to chemotherapy was an independent prognostic factor of primary central nervous system lymphomapatients.Conclusion The prognosis of primary central nervous system lymphoma is related to whether patients undergo chemotherapy or not and whether they are sensitive to chemotherapy.Sensitivity to chemotherapy is an independent factor affecting the prognosis of primary central nervous system lymphoma patients,and patients with sensitivity to chemotherapy have a relatively good prognosis.

Key words: Lymphoma, Neoplasms of the central nervous system, Prognosis, Influencing factors

摘要： 目的探讨原发性中枢神经系统淋巴瘤患者预后的影响因素。方法收集66例原发性中枢神经系统淋巴瘤患者的临床资料,包括性别、年龄、病灶数量、病灶部位、病理标记物、病理类型、治疗方式、化疗前后KPS评分等资料。对所有患者进行随访,采用单因素分析和多因素COX回归模型分析原发性中枢神经系统淋巴瘤患者预后的影响因素。结果对所有患者的单因素分析结果显示,不同性别、年龄、病灶数量、是否为深部病灶、Ki-67增殖指数、是否生发中心来源的原发性中枢神经系统淋巴瘤患者的2年总体生存率和1年无进展生存率比较,差异均无统计学意义(P＞0.05);单纯化疗或化疗联合其它治疗方式的患者,2年总体生存率和1年无进展生存率高于未进行化疗的患者,差异有统计学意义(P＜0.05);前两次化疗前后KPS评分增长大于10分的患者,判定为对化疗敏感,2年总体生存率和1年无进展生存率高于不敏感的患者(P＜0.05)。对已有确定性结局的患者进行单因素分析,对化疗敏感的患者,总体生存时间和无进展生存时间明显长于对化疗不敏感的患者。COX多因素分析结果显示,对化疗敏感是原发性中枢神经系统淋巴瘤患者预后的独立影响因素。结论原发性中枢神经系统淋巴瘤的预后与患者是否接受化疗、对化疗是否敏感有关。对化疗是否敏感是原发性中枢神经系统淋巴瘤患者预后的独立影响因素,对化疗敏感的患者,预后相对较好。

关键词: 淋巴瘤, 中枢神经系统肿瘤, 预后, 影响因素

CLC Number:

R739.4

Zhang Rui,Qi Geyao,Adilai·abudurexiti,et al.. Analysis on prognostic factors of primary central nervous system lymphoma[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2022, 35(4): 198-204.

张睿，齐戈尧，阿迪莱·阿卜杜热西提，程岗，张剑宁. 原发中枢神经系统淋巴瘤的预后因素分析[J]. 立体定向和功能性神经外科杂志, 2022, 35(4): 198-204.

References

[1] 程岗,王亚明,董超,等.原发性中枢神经系统淋巴瘤的前瞻性治疗研究[J].中华神经外科疾病研究杂志,2016,15(1):5~8.
[2] PaydasS.Primary central nervous system lymphoma:essential points in diagnosis and management[J].Med Oncol,2017,34(4):61.
[3] Shibamoto Y,Tsutsui K,Dodo Y,et al.Improved survival rate in primary intracranial lymphoma treated by high-dose radiation and systemic vincristine-doxorubicin-cyclophosphamide-prednisolone chemotherapy[J].Cancer,1990,65 (9):1907~1912.
[4] Norden AD,DrappatzJ,Wen PY,et al.Survival among patients with primary central nervous system lymphoma,1973-2004[J].J Neurooncol,2011,101(3):487~493.
[5] Iwabuchi M,Shibamoto Y,Sugie C,et al.Partial-brain radiotherapy for primary central nervous system lymphoma:multi-institutional experience[J].J Radiat Res,2016,57(2):164~168.
[6] Ahn SY,Kwon SY,Jung SH,et al.Prognosticsignificance of interim 11C-Methionine PET/CT in primary central nervous system lymphoma[J].Clin Nucl Med,2018,43(8):e259~e264.
[7] Grommes C,DeAngelis LM.Primary CNS lymphoma[J].J Clin Oncol,2017,35(21):2410~2418.
[8] Cheng G,Zhang J.Imaging features (CT,MRI,MRS,and PET/CT) of primary central nervous system lymphoma in immunocompetent patients[J].Neurol Sci,2019,40(3):535~542.
[9] 张剑宁,程岗,王亚明,等.立体定向活检诊断原发性中枢神经系统淋巴瘤( 118 例临床及影像学特征)[J].立体定向和功能性神经外科杂志,2012,25( 3) :129~133.
[10]程岗,杨帆,李庆岗,等.原发性中枢神经系统淋巴瘤MTHFR基因多态性对甲氨蝶呤代谢的影响[J].中国微侵袭神经外科杂志.2021,26(2):49~52.
[11]翁阳,高子芬,刘侃,等.弥漫性大B细胞淋巴瘤预后相关因素的研究[J].中华内科杂志,2015,44(9):681~683.
[12]高凌侠.影响原发性中枢神经系统淋巴瘤预后的因素分析[J].中国实用神经疾病杂志,2017,20(16):63~65.
[13]杜朝阳,杨如玉,李超,等.原发中枢神经系统淋巴瘤临床病理特征及其对预后的影响[J].中国实验血液学杂志,2016,24(6),1776~1781.
[14]马志萍,艾尼瓦尔·巴巴依,刘志英,等.原发中枢神经系统弥漫性大B细胞淋巴瘤临床病理、分子遗传学改变及其与预后的相关性[J].中华病理学杂志,2016,45(11):762~768.
[15]Jang JE,Kim SJ,Kim YR,et al.A new prognostic model using absolute lymphocyte count in patients with primary central nervous system lymphoma[J].European Journal of Cancer,2016,57:127~135.
[16]Bellinzona M,Roser F,Ostertag H,et al.Surgical removal of primary central nervous system lymphomas(PCNSL) presenting as space occupying lesions:a series of 33 cases[J].Eur J Surg Oncol,2005,31(1):100~105.
[17]Deangelis LM,Seiferheld W,Schold SC,et al.Combination chemotherapy and radiotherapy for primary central nervous system lymphoma:Radiation Therapy Oncology Group Study 93-10[J].J Clin Oncol,2002,20(24):4643~4648.
[18]岳春燕,朱阳敏,高雅,等.原发性中枢神经系统淋巴瘤25例临床特点和预后[J].中国老年学杂志,2016,36(16):3938~3939.
[19]朴颖哲,李鹏,刘群,等.原发性中枢神经系统淋巴瘤23例临床分析[J].中华内科杂志,2011,50(11):954~957.
[20]Gtommes C,Rubenstein JL,DeAngelis LM,et al.Comprehensive approach to diagnosis and treatment of newly diagnosed primary CNS lymphoma[J].Neuro Oncol,2019,21(3):296~305.
[21]Schaff LR,Grommes C.Updates on primary central nervous system lymphoma[J].Curr Oncol Rep,2018,20(2):1~16.
[22]Abrey LE,Ben-Porat L,Panageas KS,et al.Primary central nervous system lymphoma:the Memorial Sloan-Kettering Cancer Center prognostic model[J].J Clin Oncol,2006,24(36):5711~5715.