O'Shaughnessy Jack, Martynchyk Arina, Lee Sze Ting, Chong Geoff, Agrawal Shivam, Tatarczuch Maciej, Azryn Nariza Alysa, Gregory Gareth P, Churilov Leonid, Wang Michael, Keane Colm, Hawkes Eliza A
Olivia Newton John Cancer Research Institute at Austin Health, Australia.
Austin Health, Molecular Imaging and therapy, Melbourne, Australia.
Neurooncol Adv. 2025 May 5;7(1):vdaf090. doi: 10.1093/noajnl/vdaf090. eCollection 2025 Jan-Dec.
Primary central nervous system lymphoma (PCNSL) is an aggressive lymphoma restricted to the CNS in which outcomes cannot be reliably predicted. The International PCNSL Collaborative Group developed standardized response assessment utilizing 2-dimensional (2D) Magnetic Resonance Imaging (MRI) tumor measurements. Considerable challenges of this approach exist due to many reasons. Recent glioblastoma and PCNSL data demonstrated that radiological assessment of baseline 3-dimensional volume (3DV) as well as 3DV reduction (3DVR) may be a sensitive prognostic parameter.
Our multicentre retrospective study evaluated semiautomated 3DV in 74 PNCSL patients undergoing curative-intent chemoimmunotherapy.
Baseline tumor 3DV was not associated with survival. Compared to 3DVR < 58% (ROC-determined threshold based on our cohort), both interim and End-of-Treatment (EOT) 3DVR ≥ 58% in responding patients were associated with statistically significant prolonged 2-year progression-free survival (PFS) (interim: 73% (95%CI 57-83) versus 22% (95%CI 3-51), = 0.005; EOT: 75% (95%CI 59-85) versus 0%, = 0.002) and 2-year OS (interim: 83% (95%CI 68-91) versus 38% (95%CI 9-67), = 0.02; EOT: 86% (95%CI 70-93) versus 0%, = 0.0002). However, no significant differences in PFS or OS were observed in patients achieving standard 2D complete response (CR) compared to partial response (PR).
Although PCNSL tumor 3DV at baseline is not associated with survival outcomes, 3DVR of ≥58% in interim and EOT confers superior PFS and OS. Whereas, no difference in survival was observed using standard 2D CR versus PR response assessment at the same time-points. 3DV calculations may offer a sensitive method of response assessment for PCNSL. We are currently validating this in clinical trials.
原发性中枢神经系统淋巴瘤（PCNSL）是一种局限于中枢神经系统的侵袭性淋巴瘤，其预后无法可靠预测。国际PCNSL协作组制定了利用二维（2D）磁共振成像（MRI）肿瘤测量的标准化反应评估方法。由于多种原因，这种方法存在相当大的挑战。最近的胶质母细胞瘤和PCNSL数据表明，基线三维体积（3DV）以及三维体积缩小（3DVR）的影像学评估可能是一个敏感的预后参数。
我们的多中心回顾性研究评估了74例接受根治性化疗免疫治疗的PNCSL患者的半自动3DV。
基线肿瘤3DV与生存率无关。与3DVR<58%（基于我们队列的ROC确定阈值）相比，反应患者的中期和治疗结束（EOT）时3DVR≥58%均与统计学上显著延长的2年无进展生存期（PFS）相关（中期：73%（95%CI 57 - 83）对22%（95%CI 3 - 51），P = 0.005；EOT：75%（95%CI 59 - 85）对0%，P = 0.002）和2年总生存期（OS）（中期：83%（95%CI 68 - 91）对38%（95%CI 9 - 67），P = 0.02；EOT：86%（95%CI 70 - 93）对0%，P = 0.0002）。然而，与部分缓解（PR）相比，达到标准2D完全缓解（CR）的患者在PFS或OS方面未观察到显著差异。
尽管PCNSL基线时的肿瘤3DV与生存结果无关，但中期和EOT时3DVR≥58%可带来更好的PFS和OS。而在同一时间点使用标准2D CR与PR反应评估时，未观察到生存差异。3DV计算可能为PCNSL提供一种敏感的反应评估方法。我们目前正在临床试验中对此进行验证。
