中枢神经系统原发性弥漫性大B细胞淋巴瘤全肿瘤切除的潜在益处——一项长达十年的单中心经验
The possible benefit from total tumour resection in primary diffuse large B-cell lymphoma of central nervous system - a one-decade single-centre experience.
作者信息
Jelicic Jelena, Todorovic Balint Milena, Raicevic Sava, Ilic Rosanda, Stanisavljevic Dejana, Bila Jelena, Antic Darko, Balint Bela, Andjelic Bosko, Djurasinovic Vladislava, Sretenovic Aleksandra, Vukovic Vojin, Mihaljevic Biljana
机构信息
a Clinic of Haematology, Clinical Centre of Serbia , Belgrade , Serbia.
b Faculty of Medicine, University of Belgrade , Belgrade , Serbia.
出版信息
Br J Neurosurg. 2016;30(1):80-5. doi: 10.3109/02688697.2015.1071328. Epub 2015 Sep 4.
BACKGROUND AND METHODS
The aim of the study was to evaluate retrospectively clinical course of 27 patients with primary central nervous system lymphoma (PCNSL) diagnosed and treated by different surgical approaches. Initial therapy-diagnostic approach included surgery with total tumour reduction (TTR) performed in 12 patients (44.4%), while partial reduction and biopsy were performed in 8 (29.7%) and 7 (25.9%) patients, respectively. All patients were treated with chemotherapy based on high-dose methotrexate (HD-MTX) with/without whole-brain radiotherapy (WBRT).
RESULTS
The median overall survival (OS) and event-free survival were 37 and 31 months, respectively, with overall response rate of 74%. The patients who underwent an open surgery with TTR had significantly longer OS (median not reached), comparing with partial tumour reduction or biopsy only (Log-Rank χ(2) 6.08, p = 0.014) when median OS was 23 months. In patients with performance status according to Eastern Cooperative Oncology Group (ECOG PS) ≥ 3, OS was 23 months, contrary to ECOG PS 1-2 when median was not reached. The International Extranodal Lymphoma Study Group score (low, intermediate and high) also influenced OS between three risk groups (Log-Rank χ(2) 12.5, p = 0.002).
CONCLUSION
The treatment of PCNSL still remains doubtful, however possible benefit from the TTR followed with HD-MTX with/without WBRT should be reconsidered.
背景与方法
本研究旨在回顾性评估27例经不同手术方式诊断和治疗的原发性中枢神经系统淋巴瘤（PCNSL）患者的临床病程。初始治疗诊断方法包括：12例患者（44.4%）接受了肿瘤全切除（TTR）手术，8例患者（29.7%）接受了部分切除和活检，7例患者（25.9%）仅接受了活检。所有患者均接受了基于大剂量甲氨蝶呤（HD-MTX）的化疗，部分患者联合或未联合全脑放疗（WBRT）。
结果
中位总生存期（OS）和无事件生存期分别为37个月和31个月，总缓解率为74%。接受TTR开放手术的患者的OS显著更长（未达到中位值），而仅接受部分肿瘤切除或活检的患者的中位OS为23个月（对数秩检验χ(2) 6.08，p = 0.014）。根据东部肿瘤协作组（ECOG PS）评分为≥ 3的患者的OS为23个月，而ECOG PS为1-2的患者未达到中位值。国际结外淋巴瘤研究组评分（低、中、高）也影响了三个风险组之间的OS（对数秩检验χ(2) 12.5，p = 0.002）。
结论
PCNSL的治疗仍存在疑问，然而，应重新考虑TTR后联合或不联合WBRT的HD-MTX治疗可能带来的益处。
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