Lee Chaejin, Byeon Yukyeng, Kim Gung Ju, Jeon Juhee, Hong Chang Ki, Kim Jeong Hoon, Kim Young-Hoon, Cho Young Hyun, Hong Seok Ho, Chong Sang Joon, Song Sang Woo
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea.
Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Cancers (Basel). 2025 Mar 7;17(6):917. doi: 10.3390/cancers17060917.
The management of primary central nervous system lymphoma (PCNSL) has traditionally prioritized diagnostic biopsy, with surgical resection often considered secondary due to risks and potential bias in previous studies, which included patients with deep or multiple tumors. This study aims to evaluate the impact of surgical resection on survival in patients with solitary, resectable PCNSL. We conducted a retrospective analysis of PCNSL patients treated via brain biopsy or surgical resection at our institution between January 2010 and December 2022. Cases with deep-located tumors (corpus callosum, basal ganglia, thalamus, and brainstem) or multiple lesions were excluded. Survival and clinical outcomes were compared between the two groups. A total of 79 patients (30 resection and 49 biopsy) were included. No significant differences were observed between groups regarding demographics, comorbidities, tumor characteristics, or International Extranodal Lymphoma Study Group scores. Preoperative midline shifting ( = 0.048) and steroid use ( < 0.001) were higher in the resection group, which also demonstrated greater symptom improvement ( < 0.001). The complication rates were comparable between groups. The 5-year overall survival (OS) was 81.3% (resection) vs. 80.1% (biopsy), and the 5-year progression-free survival (PFS) was 53.6% (resection) vs. 60.3% (biopsy), with no significant differences in OS or PFS by Cox regression analysis. Surgical resection does not improve OS or PFS in solitary, resectable PCNSL, though it may provide symptomatic relief in select cases. Further prospective studies are needed to define its role in PCNSL management.
原发性中枢神经系统淋巴瘤（PCNSL）的治疗传统上优先考虑诊断性活检，由于先前研究中存在风险和潜在偏倚（这些研究纳入了深部或多发肿瘤患者），手术切除通常被视为次要选择。本研究旨在评估手术切除对孤立性、可切除性PCNSL患者生存的影响。我们对2010年1月至2022年12月期间在本机构接受脑活检或手术切除治疗的PCNSL患者进行了回顾性分析。排除深部肿瘤（胼胝体、基底神经节、丘脑和脑干）或多发病变的病例。比较两组的生存情况和临床结果。共纳入79例患者（30例行手术切除，49例行活检）。两组在人口统计学、合并症、肿瘤特征或国际结外淋巴瘤研究组评分方面未观察到显著差异。手术切除组术前中线移位（=0.048）和使用类固醇药物（<0.001）的比例更高，该组症状改善也更明显（<0.001）。两组并发症发生率相当。5年总生存率（OS）分别为手术切除组81.3%，活检组80.1%；5年无进展生存率（PFS）分别为手术切除组53.6%，活检组60.3%，Cox回归分析显示OS或PFS无显著差异。对于孤立性、可切除性PCNSL，手术切除并不能改善OS或PFS，尽管在某些情况下可能缓解症状。需要进一步的前瞻性研究来明确其在PCNSL治疗中的作用。
