Department of Neurosurgery, GHU-Paris Psychiatrie et Neurosciences, Hôpital Sainte Anne, 1 rue Cabanis, 75014, Paris Cedex 14, France.
Institute of Psychiatry and Neuroscience of Paris, IMABRAIN, INSERM U1266, Université de Paris, F-75014, Paris, France.
J Neurooncol. 2022 Sep;159(2):347-358. doi: 10.1007/s11060-022-04069-6. Epub 2022 Jun 27.
Brain surgery is required to ascertain the diagnosis of central nervous system lymphoma. We assessed the diagnostic yield and safety of the surgical procedures, the predictors of postoperative morbidity, and of overall survival.
Observational single-institution retrospective cohort study (1992-2020) of 101 consecutive adult patients who underwent stereotactic biopsy, open biopsy, or resection for a newly diagnosed central nervous system lymphoma.
The diagnostic yield was 100% despite preoperative steroid administration in 48/101 cases (47.5%). A preoperative Karnofsky Performance Status score less than 70 (p = 0.006) was an independent predictor of a new postoperative focal neurological deficit (7/101 cases, 6.9%). A previous history of hematological malignancy (p = 0.049), age 65 years or more (p = 0.031), and new postoperative neurological deficit (p < 0.001) were independent predictors of a Karnofsky Performance Status score decrease 20 points or more postoperatively (13/101 cases, 12.9%). A previous history of hematological malignancy (p = 0.034), and preoperative Karnofsky Performance Status score less than 70 (p = 0.024) were independent predictors of postoperative hemorrhage (13/101 cases, 12.9%). A preoperative Karnofsky Performance Status score less than 70 (p = 0.019), and a previous history of hematological malignancy (p = 0.014) were independent predictors of death during hospital stay (8/101 cases, 7.9%). In the 82 immunocompetent patients harboring a primary central nervous system lymphoma, age 65 years or more (p = 0.044), and time to hematological treatment more than 21 days (p = 0.008), were independent predictors of a shorter overall survival. A dedicated hematological treatment (p < 0.001) was an independent predictor of a longer overall survival.
Brain biopsy is feasible with low morbidity for central nervous system lymphomas. Postoperatively, patients should be promptly referred for hematological treatment initiation.
中枢神经系统淋巴瘤需要进行脑部手术以明确诊断。我们评估了手术的诊断效果和安全性、术后发病率的预测因素，以及总生存率。
这是一项观察性的单机构回顾性队列研究（1992 年至 2020 年），共纳入 101 例新诊断为中枢神经系统淋巴瘤的成年患者，他们接受了立体定向活检、开放性活检或切除术。
尽管 48/101 例（47.5%）患者术前接受了类固醇治疗，但诊断率仍达到 100%。术前 Karnofsky 表现状态评分低于 70 分（p=0.006）是术后新发局灶性神经功能缺损的独立预测因素（101 例中有 7 例，6.9%）。既往血液系统恶性肿瘤史（p=0.049）、年龄 65 岁或以上（p=0.031）和术后新发神经功能缺损（p<0.001）是术后 Karnofsky 表现状态评分下降 20 分或以上的独立预测因素（101 例中有 13 例，12.9%）。既往血液系统恶性肿瘤史（p=0.034）和术前 Karnofsky 表现状态评分低于 70 分（p=0.024）是术后出血的独立预测因素（101 例中有 13 例，12.9%）。术前 Karnofsky 表现状态评分低于 70 分（p=0.019）和既往血液系统恶性肿瘤史（p=0.014）是住院期间死亡的独立预测因素（101 例中有 8 例，7.9%）。在 82 例免疫功能正常的原发性中枢神经系统淋巴瘤患者中，年龄 65 岁或以上（p=0.044）和血液系统治疗开始时间超过 21 天（p=0.008）是总生存率较短的独立预测因素。专门的血液学治疗（p<0.001）是总生存率延长的独立预测因素。
中枢神经系统淋巴瘤的脑部活检具有较低的发病率，是可行的。术后应及时转介患者开始血液学治疗。
