Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
Department of Neurosurgery, Outram Road, Singapore, 169608, Singapore.
J Neurooncol. 2021 Jan;151(2):295-306. doi: 10.1007/s11060-020-03665-8. Epub 2021 Jan 4.
Central nervous system lymphomas (CNSL) can present with motor and non-motor symptoms. In many central nervous system tumors, motor deficits are associated with significant morbidity and functional impairment, and correlate with worse prognosis. CNSLs however, often exhibit remarkable response to chemotherapy and radiotherapy with corresponding symptom improvement. We investigate the survival outcomes and trajectories of motor and functional recovery in a cohort of patients presenting with and without initial motor deficits.
Patients who underwent biopsy and with a histologically confirmed CNSL between 2008 and 2019 were retrospectively identified. Baseline demographic variables, comorbidities, presenting symptoms, histological type, neuroimaging features (location and number of lesions), and treatment administered (pre- and post-operative steroid use and chemotherapy regime) were recorded. Dates of death were obtained from the National Registry of Births and Deaths. Motor power and performance status at admission, 1 month and 6 months were determined.
We identified 119 patients, of whom 34% presented with focal motor deficits. The median overall survival (OS) was 26.6 months. Those with focal motor deficits had longer OS (median 42.4 months) than those without (median 23.3 months; p = 0.047). In multivariate Cox analysis, age (HR 1.04 per year; p = 0.003), CCI (HR 1.31 per point; p < 0.001), leptomeningeal/ependymal involvement (HR 2.53; p = 0.016), thalamus involvement (HR 0.34; p = 0.019), neutrophil:lymphocyte ratio (HR 1.06 per point; p = 0.034), positive HIV status (HR 5.31; p = 0.003), preoperative steroids use (HR 0.49; p = 0.018), postoperative high-dose steroids (HR 0.26; p < 0.001) and postoperative low-dose steroids (HR 0.28; p = 0.010) were significant predictors of OS. By one month, 43% of surviving patients had full power, increasing to 61% by six months.
A significant proportion of patients with initial motor deficits recovered in motor strength by six months. In our population, those presenting with motor deficits had paradoxically better overall survival.
中枢神经系统淋巴瘤（CNSL）可出现运动和非运动症状。在许多中枢神经系统肿瘤中，运动缺陷与显著的发病率和功能障碍相关，并与预后较差相关。然而，CNSL 通常对化疗和放疗有显著的反应，症状也相应改善。我们调查了一组有和没有初始运动缺陷的患者的生存结果和运动及功能恢复轨迹。
回顾性分析了 2008 年至 2019 年间接受活检且组织学证实为 CNSL 的患者。记录了基线人口统计学变量、合并症、首发症状、组织学类型、神经影像学特征（病变部位和数量）以及所给予的治疗（术前和术后类固醇使用和化疗方案）。从国家出生和死亡登记处获得死亡日期。入院时、1 个月和 6 个月时确定运动力量和表现状态。
我们确定了 119 名患者，其中 34%有局灶性运动缺陷。中位总生存期（OS）为 26.6 个月。有局灶性运动缺陷的患者 OS 更长（中位 42.4 个月），而无局灶性运动缺陷的患者 OS 更短（中位 23.3 个月；p=0.047）。在多变量 Cox 分析中，年龄（每年增加 1.04；p=0.003）、CCI（每增加 1 分增加 1.31；p<0.001）、软脑膜/室管膜受累（HR 2.53；p=0.016）、丘脑受累（HR 0.34；p=0.019）、中性粒细胞：淋巴细胞比值（每增加 1 分增加 1.06；p=0.034）、HIV 阳性（HR 5.31；p=0.003）、术前使用类固醇（HR 0.49；p=0.018）、术后大剂量类固醇（HR 0.26；p<0.001）和术后低剂量类固醇（HR 0.28；p=0.010）是 OS 的显著预测因素。一个月时，43%的存活患者的运动力量完全恢复，到 6 个月时增加到 61%。
相当一部分有初始运动缺陷的患者在 6 个月时运动力量恢复。在我们的人群中，有运动缺陷的患者的总体生存情况反而更好。
