Schellekes Nadav, Barbotti Arianna, Abramov Yael, Sitt Razi, Di Meco Francesco, Ram Zvi, Grossman Rachel
1Department of Neurosurgery, Tel Aviv Medical Center, Tel Aviv, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and.
2Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy.
J Neurosurg. 2021 Feb 26;135(4):1016-1025. doi: 10.3171/2020.9.JNS201980. Print 2021 Oct 1.
Primary central nervous system lymphoma (PCNSL) is a rare CNS tumor with a poor prognosis. It is usually diagnosed by needle biopsy and treated mainly with high-dose chemotherapy. Resection is currently not considered a standard treatment option. A possible prolonged survival after resection of PCNSL lesions in selected patients has been suggested, but selection criteria for surgery, especially for solitary lesions, have never been established.
The authors retrospectively searched their patient database for records of adult patients (≥ 18 years) who were diagnosed and treated for a solitary PCNSL between 2005 and 2019. Patients were divided into groups according to whether they underwent resection or needle biopsy. Statistical analyses were performed in an attempt to identify variables affecting outcome and possible survival advantage and to characterize subgroups of patients who would benefit from resection of their tumor compared with undergoing biopsy only.
A total of 113 patients with a solitary lesion of PCNSL were identified; 36 patients underwent resection, and 77 had a diagnostic stereotactic biopsy only. The statically significant preoperative risk factors included age ≥ 70 years (adjusted HR 9.61, 95% CI 2.42-38.11; p = 0.001), deep-seated lesions (adjusted HR 3.33, 95% CI 1.13-9.84; p = 0.030), and occipital location (adjusted HR 4.26, 95% CI 1.08-16.78; p = 0.039). Having a postoperative Karnofsky Performance Scale (KPS) score < 80 (adjusted HR 3.21, 95% CI 1.05-9.77; p = 0.040) and surgical site infection (adjusted HR 4.27, 95% CI 1.18-15.47; p = 0.027) were significant postoperative risk factors after the adjustment and selection by means of other possible risk factors. In a subgroup analysis, patients younger than 70 years who underwent resection had a nonsignificant trend toward longer survival than those who underwent needle biopsy (median survival 35.0 months vs 15.2 months, p = 0.149). However, patients with a superficial tumor who underwent resection had significantly longer survival times than those who underwent needle biopsy (median survival 34.3 months vs 8.9 months, p = 0.014). Patients younger than 70 years who had a superficial tumor and underwent resection had significantly prolonged survival, with a median survival of 35.0 months compared with 8.9 months in patients from the same group who underwent needle biopsy (p = 0.007).
Specific subgroups of patients with a solitary PCNSL lesion might gain a survival benefit from resection compared with undergoing only a diagnostic biopsy.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的中枢神经系统肿瘤，预后较差。通常通过针吸活检进行诊断，主要采用大剂量化疗进行治疗。目前，手术切除不被视为标准治疗选择。有研究表明，部分经选择的患者在切除PCNSL病灶后可能生存期延长，但手术的选择标准，尤其是孤立性病灶的选择标准尚未确立。
作者回顾性检索其患者数据库，查找2005年至2019年间诊断并治疗的孤立性PCNSL成年患者（≥18岁）的记录。根据患者是否接受手术切除或针吸活检进行分组。进行统计分析，试图确定影响预后的变量和可能的生存优势，并描述与仅接受活检相比，肿瘤切除可能受益的患者亚组特征。
共确定113例孤立性PCNSL病灶患者；36例接受了手术切除，77例仅进行了诊断性立体定向活检。具有统计学意义的术前危险因素包括年龄≥70岁（校正风险比9.61，95%置信区间2.42 - 38.11；p = 0.001）、深部病灶（校正风险比3.33，95%置信区间1.13 - 9.84；p = 0.030）和枕叶部位（校正风险比4.26，95%置信区间1.08 - 16.78；p = 0.039）。术后卡氏功能状态评分（KPS）<80（校正风险比3.21，95%置信区间1.05 - 9.77；p = 0.040）和手术部位感染（校正风险比4.27，95%置信区间1.18 - 15.47；p = 0.027）是经调整并排除其他可能危险因素后的显著术后危险因素。在亚组分析中，年龄小于70岁且接受手术切除的患者与接受针吸活检的患者相比，生存期有延长趋势但无统计学意义（中位生存期35.0个月对15.2个月，p = 0.149）。然而，浅表肿瘤患者接受手术切除后的生存期明显长于接受针吸活检的患者（中位生存期34.3个月对8.9个月，p = 0.014）。年龄小于70岁且有浅表肿瘤并接受手术切除的患者生存期显著延长，中位生存期为35.0个月，而同一组接受针吸活检的患者中位生存期为8.9个月（p = 0.007）。
与仅进行诊断性活检相比，孤立性PCNSL病灶的特定亚组患者可能从手术切除中获得生存益处。
