Clinical Analysis Of 29 Cases Of Primary Central Nervous System Lymphoma

Obiective : Primary central nervous system lymphoma(PCNSL)is an aggressive malignancy confined to the brain,spinal cord,leptomeninges,and eyes.Due to its rarity,many factors such as diagnosis and treatment need to be explored,this study was aimed to analyse the clinical manifestations,auxiliary examinations,diagnosis,treatment and related prognosis factors of PCNSL and to provide a reference for the diagnosis and treatment of PCNSL.Methods:The clinical data of 29 patients pathologically diagnosed as PCNSL in Qingdao University Affiliated Hospital were summarized and the related factors were analyzed retrospectively from January 2010 to December 2017.Results :(1)The patients comprised 16 males and 13 females(with a male to female ratio of 1.23∶1),with a median age of 60 years(range 22-73,average 57.6),Among them,there were 14 cases at the age of 60 and 15 cases at or below 60 years of age.The First symptoms involved in intracranial hypertension(62.1%)included headache,nausea,vomiting,and fatigue(51.7%).The lesions were mostly located in the frontal lobe(34.5%).The ratio of single lesions to multiple lesions was 1.07:1(15 single lesions and 14 multiple lesions).The majority of patients had an ECOG score of ≤1(19)at the first visit.The pathological diagnosis of 29 cases was diffuse large B-cell lymphoma,of which 25 cases were non-genetic center(Non-GCB)and the other 4 cases failed to be typed.(2)For diagnosis,except for 4 patients who underwent stereotactic biopsy,all patients underwent tumor resection.Among them,14 patients underwent full-thickness lesions and 11 patients underwent partial resection.In the treatment,4 received single surgery or biopsy(13.8%),9 received chemotherapy alone(31.0%),6 received radiotherapy alone(20.7%),and 10 received surgery combined with chemotherapy and radiotherapy(34.5%).(3)The survival analysis showed the mean survival was 25 months(7.89-42.1),and the1,2,3-year overall survival(OS)rates were 74.66%,53.1%,and 34.5%,respectively.The K-M survival analysis showed that age ≤ 60 years,single lesion,chemotherapy combined with radiotherapy,and conventional chemotherapy combined with rituximab were favorable prognostic factors for survival(P = 0.025,0.020,0.046,0.036,respectively).Multivariate analysis by COX regression showed that age,number of lesions,and physical fitness were independent prognostic factors for this group of patients.Conclusion :(1)The median age of PCNSL is 60 years old.PCNSL often appeared with nonspecific symptoms.The first symptoms are mostly elevated intracranial pressure and fatigue,etc.The lesions are often located in the frontal lobe,and the ratio of multiple lesions to single lesions is close.(2)The definite diagnosis of PCNSL depends on the pathological examination.Most PCNSL originate from large B-cells,non-germinal center sources(Non-GCB type)are more common than germinal center sources(GCB type),accounting for 25/29.(3)PCNSL has poor therapeutic effect and poor prognosis.The mean survival of this group of patients was 25 months(7.89-42.1),and the 1,2,3-year overall survival(OS)rates were 74.66%,53.1%,and 34.5%,respectively.(4)Combined use of chemotherapy and radiotherapy and conventional chemotherapy combined with rituximab may prolong the OS.(5)The age,physical fitness,and number of lesions were independent prognostic factors for this group of patients.