Rudresha A H, Chaudhuri Tamojit, Lakshmaiah Kuntegowdanahalli C, Babu Govind, Lokesh K N, Rajeev L K
Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
South Asian J Cancer. 2017 Oct-Dec;6(4):165-168. doi: 10.4103/2278-330X.221341.
Primary central nervous system lymphoma (PCNSL) is a rare form of aggressive extranodal non-Hodgkin's lymphoma which occurs in both immunocompromised and immunocompetent patients. It has an overall poor prognosis in spite of a multimodality treatment approach including chemotherapy and radiotherapy. This study attempts to further delineate the clinicopathological, immunohistochemical, and radiological profile of PCNSL at Kidwai Memorial Institute of Oncology, Karnataka, India.
All the pathologically confirmed PCNSL cases between January 2010 and June 2016, at our center, were analyzed retrospectively. The influence of potential prognostic parameters on overall survival (OS) was investigated by log-rank test and Cox regression analysis.
Of the 26 PCNSL patients, 17 (65.3%) were males. Median age at diagnosis was 42.5 years. None of the patients had HIV or Epstein-Barr virus positivity and only four patients (15.4%) had B-symptoms. The most common location in the brain was cerebral hemispheres in 15 patients (57%) and 10 patients (38.5%) had multiple intracranial lesions. Histologically, all were diffuse large B-cell lymphomas, except one case of anaplastic large cell lymphoma. Immunohistochemically, 18 patients (69%) had MUM 1 positivity and 20 cases (77%) belonged to nongerminal center subtype. DeAngelis protocol was followed in 24 patients (92%), and among this cohort, Memorial Sloan Kettering Cancer Center Class 1 ( = 17) and Class 2 ( = 7) patients had a median OS of 25 months and 11 months, respectively.
None of the potential prognostic factors had a statistically significant influence on OS in our patients. High-dose methotrexate combined with radiation is an effective therapeutic approach. However, further prospective studies with a large number of patients are needed to identify more effective primary chemotherapy regimens to further improve the treatment outcome.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的侵袭性结外非霍奇金淋巴瘤，见于免疫功能低下和免疫功能正常的患者。尽管采用了包括化疗和放疗在内的多模式治疗方法，其总体预后仍然较差。本研究旨在进一步描述印度卡纳塔克邦基德瓦伊肿瘤研究所PCNSL的临床病理、免疫组化和放射学特征。
对2010年1月至2016年6月期间在本中心经病理确诊的所有PCNSL病例进行回顾性分析。通过对数秩检验和Cox回归分析研究潜在预后参数对总生存期（OS）的影响。
26例PCNSL患者中，17例（65.3%）为男性。诊断时的中位年龄为42.5岁。所有患者均无HIV或EB病毒阳性，仅4例（15.4%）有B症状。脑内最常见的部位是大脑半球，15例（57%），10例（38.5%）有多个颅内病变。组织学上，除1例间变性大细胞淋巴瘤外，均为弥漫性大B细胞淋巴瘤。免疫组化方面，18例（69%）MUM 1阳性，20例（77%）属于非生发中心亚型。24例（92%）采用了DeAngelis方案，在该队列中，纪念斯隆凯特琳癌症中心1级（n = 17）和2级（n = 7）患者的中位OS分别为25个月和11个月。
在我们的患者中，没有潜在的预后因素对OS有统计学上的显著影响。大剂量甲氨蝶呤联合放疗是一种有效的治疗方法。然而，需要进一步开展大量患者的前瞻性研究，以确定更有效的一线化疗方案，进一步改善治疗效果。
