| Background and objective:Primary central nervous system lymphoma(PCNSL)is a rare subtype of non-Hodgkin lymphoma(NHL).Despite recent therapeutic advances,these malignancies exhibit one of the worst prognoses among NHL.In this study,we retrospectively analyzed the clinical features,treatment and prognostic factors in PCNSL patients.Materials and methods:41 cases of PCNSL patients diagnosed by pathology were obtained in Jiangxi Provincial Cancer Hospital from 2004 to 2018,and their clinical data were analyzed.Grouped according to surgery,high-dose methotrexate(HD-MTX),combined with temozolomide and rituximab,the survival analysis of these four groups were compared.Univariate analysis was performed on factors such as gender,age,ECOG score,serum LDH level,whether germinal center B-cell like and intrathecal chemotherapy,which may affect prognosis.Statistical analysis was performed using IMB SPSS Statistics 22.0 statistical software;Kaplan-Meier(K-M)method was used to survival analysis;Log-rank test was used to compare differences between groups;Cox regression model was used to analyze multiple prognostic factors.Statistical significance was defined as P <0.05.Resulte:(1)Patients characteristics: A total of 41 patients were collected in this retrospective study,23 males and 18 females,male to female ratio was 1.3:1.The median age at diagnosis was 54(range 25 to 79)years.In this group,There were 25 patients with a age of 60 or less,13 patients with ECOG<2 and 12 patients with elevated serum LDH.The most common pathological types was diffuse large B-cell lymphoma with 38 cases(92.7%).According to the results of immunohistochemistry,11 patients were GCB subtypes and 24 patients were non-GCB subtypes.The common initial clinical symptom were increased intracranial pressure and sensory or motorial disorder.(2)Survival analysis:The median follow-up time 29(rang 16 to 66)months.Complete response in 20(48.7%)patients,partial response in 13(31.7%)patients,and 6(14.6%)patients with progressive disease.The objective response rate was 80.5%.The median PFS for all patients was 20 months(95%CI:17.2-22.8 months),with a median OS of 36 months(95%CI:31.9-40.1 months).The 3-year progression-free survival and 3-year overal survival rates were 25% and 49.8%.The median PFS of the surgical treatment group and non-surgical treatment group were 21 months(95%CI:14.3-27.7months)and 19months(95%CI:17.7-20.3 months),with a median OS of 36 months(95%CI : 25.2-46.8months)and 38 months(95%CI :26.4-49.6months),There were no significance differences of survival rate between the two groups(PFS: P=0.462;OS: P=0.910).The median PFS and median OS of patients in the HD-MTX treatment group were higher than that in the non-HD-MTX treatment group.The median PFS of TMZ treatment group and non-TMZ treatment group were 19 months(95% CI: 14.9-23.1months)and 20 months(95%CI:16.0-24.0),with a median OS of 37 months(95% CI: 31.6-42.4)and 35 months(95%CI :24.2-45.8),There were no significance differences of survival rate between the two groups(PFS:P=0.788;OS:P=0.858).The median PFS and median OS of patients in the rituximab treatment group were higher than that in the non-rituximab treatment group.(3)Prognostic factors: Univariate analysis showed that age,ECOG scores standard and serum LDH levels were associated with prognosis.Multivariate analysis showed That age and ECOG scores standard were independent prognostic factors in patients with PCNSL.Conclusion:The most common pathologic phenotype of PCNSL was DLBCL.In PCNSL patients,surgical treatment and combined with temozolomide treatment did not show survival benefits,HD-MTX-containing regimens and treatment with rituximab prolonged PFS and OS.Age and ECOG score were independent prognostic factors. |
PDF Full Text Request