| Background: Primary central nervous system lymphoma(PCNSL)belongs to extranodal non-Hodgkinlymphoma,Clinically rare,accounting for about 3.1%in the central nervous system(CNS)tumors[1,2],for systemic non-Hodgkinlymphoma 1%-2%[3],Can be found in various parts of the central nervous system,common violations of brain parenchyma,spinal cord,pia mater and other parts.Foreign studies have shown that the occurrence of the disease is more related to immunodeficiency and the use of immunosuppressive agents after organ transplantation.It occurs in people with normal immune function and has not been found to be associated with common viruses such as herpes virus.The age of onset is 50 years old[4,5].The most common of these is the primary central nervous system diffuse large B-cell lymphomas(PCNS DLBCL),which is a highly malignant tumor that originates in the central nervous system and accounts for about 95% of the primary central nervous system lymphoma[6].In recent years,the incidence has increased,with the application of antiviral drugs,the incidence of immunodeficiency patients has decreased compared with before,and the population with normal immune function has increased more significantly[3,7].Alizadeh et al,used DNA microarray technology to determine two types of diffuse large B-cell lymphomas in the primary central nervous system based on gene expression patterns at different stages of B-cell differentiation: a gene that expresses germinal center B cells(The germinal centre B-like DLBCL,GCB),another expression can induce activated B-like DLBCL in peripheral blood B cells,and find that the primary central nervous system that expresses germinal center B cells is diffuse the survival rate of patients with B-cell lymphoma is significantly higher than that of patients who can induce peripheral blood B cells to activate genes in vitro[8].Coulon et al[9],reported that 80% of the primary central nervous system lymphoma was single supratentorial lesion,multiple lesionsaccounted for 20%,about 1/3 tumors were located in the deep part of the brain,and 10% in the posterior cranial fossa.Most of the lesions on CT showed iso-density or high-density,and this proportion reached 92%,on MRI,almost all cases showed low signal or equal signal on T1-weighted images,about 40% of cases were T2-weighted images show high signals,although almost all cases can be enhanced,and generally have uniform enhancement,peripheral edema,the border is more clear,a few with bleeding or necrosis[9,10].The treatment of Primary central nervous system diffuse large B-cell lymphomas is mainly surgical excision,but it is often difficult to achieve total resection because of some factors.Traditional programs to determine the prognosis of patients with the following factors,often based on age,tumor location,whether the transfer and other factors,many of which are doped with subjective assumptions.Therefore,the study of Primary central nervous system diffuse large B-cell lymphomas,to find out the prognostic indicators,to further guide the treatment is very necessary.Aim: In this part of the retrospective study of patients with Primary central nervous system diffuse large B-cell lymphomas who were archived treatment in the first hospital of Jilin University from 2005 to 2016,tend to summarizes the clinical features of Primary central nervous system diffuse large B-cell lymphomas Kinds of treatment,with a variety of clinical factors univariate and multivariate survival prognosis analysis.Facilitate clinical work.Methods :This part of the study retrospectively studied the cases of patients with Primary central nervous system diffuse large B-cell lymphomas who had archived the medical records of the First Hospital of Jilin University from2005 to 2016.The data were entered into the Excel spreadsheet one by one(Microsoft Office 2010)Use IMB SPSS Statistics 20 software for statistical analysis.The factors such as Sex,age,tumor location and depth,course of disease,multiple single,peritumoral edema,immunophenotyping,degree of resection,postoperative adjuvant treatment and preoperative KPS score,were analyzed as univariate analysis.Kaplan-Meier(K-M)method and Log-Rank method were used for survival analysis to compare the differences between groups.The two-sided test was statistically significant when P was greater than 0.05.Finally,COX regression multivariate model analysis to study the impact of many factors on the prognosis and determine the final influencing factors.Results:Thirty-one patients were enrolled in the study.There were 19 males and 12 females.The male to female ratio was 1.58:1.The age distribution ranged from 9 to 72 years,with a median age of 56 years,an average age of 52.1 years,≥60 years in 16 cases,and <60 years in 15 cases,with a ratio of 1.1:1.Tumor invasion of deep brain tissue in 15 cases.According to preoperative MRI,there were 21 single cases,10 multiple cases,20 cases with no or mild edema,and 11 cases with moderate or severe edema.According to the classification of immune results,there were 16 cases of GCB type and 15 cases of non-GCB type.According to the classification of intraoperative and postoperative reexamination,there were 22 cases of total incision,4 cases of major incision,and 5 cases of biopsy.22 patients were treated with adjuvant therapy and 9 were not treated with adjuvant therapy.Preoperative KPS score 80-100 points in 15 cases,40-70 points in11 cases,≤ 30 points in 5 cases.Conclusion: Univariate analysis revealed that tumor invasion and deep brain tissue,medium or severe peritumoral edema,immunohistochemical classification non-GCB,surgical excision or biopsy,and postoperative radiochemotherapy were associated with poor prognosis of PCNS DLBCL(P<0.05).).Cox regression analysis found that incomplete resection(P=0.001)and no postoperative radiochemotherapy(P=0.000)were associated with poor prognosis of PCNS DLBCL.. |
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