原发性中枢神经系统淋巴瘤的细胞减灭术：是否到了考虑切除范围的时候？

Cytoreductive Surgery for Primary Central Nervous System Lymphoma: Is it time to consider extent of resection?

机构信息

Department of Neurosurgery, Monash Health, Level 5, Block D, 246 Clayton Road, Clayton, Victoria 3168, Australia.

Data Manager & Research Affiliate, Department of Surgery, Dandenong Hospital, Melbourne, Australia.

出版信息

J Clin Neurosci. 2022 Dec;106:110-116. doi: 10.1016/j.jocn.2022.10.008. Epub 2022 Oct 21.

DOI:10.1016/j.jocn.2022.10.008

PMID:36274297

Abstract

BACKGROUND

Cytoreductive surgery for Primary Central Nervous System Lymphoma (PCNSL) is controversial and is not routinely practiced. Cumulative literature in recent years, however, suggests a potential survival benefit associated with a greater extent of resection.

METHODS

A retrospective single institution cohort analysis of 58 consecutive patients with PCNSL was conducted between January 2011 and December 2020. Demographic, clinical, and radiographic characteristics were compared between patients with and without cytoreductive surgery following diagnosis of PCNSL. The primary outcome measures were progression-free survival (PFS) and overall survival (OS). Secondary outcome measures included time to remission (TTR), time to chemotherapy (TTC) and response to initial chemotherapy (RIC).

RESULTS

Forty-six patients (79.3 %) received stereotactic biopsy and 12 (20.6 %) underwent cytoreductive surgery. There was a trend towards longer OS (29.8 vs 22.3 months, p = 0.672), shorter TTR (4.0 vs 4.7 months, p = 0.362), and greater complete or near-complete radiographic RIC (81.8 % vs 67.6 %, p = 0.367) for patients undergoing cytoreductive surgery. This correlated with a lesser need for whole brain radiotherapy (WBRT) (8.3 % vs 19.6 %, p = 0.359).

CONCLUSION

Our data suggests a potential benefit of cytoreductive surgery for selected patients diagnosed with PCNSL. Although not statistically significant, there was a trend towards improved OS, reduced TTR, greater RIC, and reduced WBRT requirement. Further studies with better randomization and statistical power are needed to validate this correlation.

摘要

背景

原发性中枢神经系统淋巴瘤（PCNSL）的细胞减灭术存在争议，并未常规施行。然而，近年来的文献累积表明，更大程度的切除术与生存获益相关。

方法

对 2011 年 1 月至 2020 年 12 月期间在单一机构进行的 58 例 PCNSL 连续患者进行回顾性单机构队列分析。比较诊断为 PCNSL 后行细胞减灭术与不行细胞减灭术患者的人口统计学、临床和影像学特征。主要结局指标为无进展生存期（PFS）和总生存期（OS）。次要结局指标包括缓解时间（TTR）、化疗时间（TTC）和初始化疗反应（RIC）。

结果

46 例患者（79.3%）接受立体定向活检，12 例患者（20.6%）行细胞减灭术。行细胞减灭术的患者 OS 更长（29.8 与 22.3 个月，p=0.672）、TTR 更短（4.0 与 4.7 个月，p=0.362）、RIC 完全或接近完全的比例更高（81.8%与 67.6%，p=0.367）。这与 WBRT 的需求较低相关（8.3%与 19.6%，p=0.359）。