Ling S M, Roach M, Larson D A, Wara W M
Department of Radiation Oncology, University of California San Francisco, San Francisco 94143.
Cancer. 1994 May 15;73(10):2570-82. doi: 10.1002/1097-0142(19940515)73:10<2570::aid-cncr2820731019>3.0.co;2-1.
Classic human immunodeficiency virus (HIV) negative primary central nervous system lymphoma (PCNSL) is a relatively uncommon occurrence, whereas the incidence of HIV positive PCNSL has increased dramatically during the past 5 years. Between 2% and 6% of all patients with acquired immune deficiency syndrome (AIDS) will have PCNSL develop clinically, and as many as 11% will have PCNSL found at autopsy. In the United States, some of the earliest and most extensive experience with HIV positive PCNSL has occurred in San Francisco. This article reports on PCNSL in patients with and without HIV.
Using our diagnosis-based computer retrieval system, we identified all patients treated with radiotherapy for PCNSL between January 1982 and January 1992 and reviewed their medical records. Population characteristics, risk factors and length of survival (LOS), were analyzed. Statistical methodology included the Cox proportional hazards model and Kaplan-Meier survival curves.
Fifty-six patients were identified with PCNSL, of which 41 were HIV positive and 15 were HIV negative. There was a fourfold increase in the total number of PCNSL cases during the time period 1987-1991 as compared with the preceding 5 years; these cases primarily were in the HIV positive group. The average Karnofsky performance score (KPS) in the HIV positive group was 50, whereas in the HIV negative group, the KPS was 35. However, the median LOS in the HIV positive group was 3 months, whereas in the HIV negative group it was 20 months. Within each group, there was a statistically significant correlation between KPS and LOS.
Patients with HIV and PCNSL have a much shorter median LOS than do patients with PCNSL but without HIV; however, the outcome for both groups is dismal. Randomized clinical trials are needed to determine which patients with HIV might benefit from more aggressive therapy and to determine the optimal choice and dosages of chemoradiation therapy for patients with PCNSL without HIV.
经典的人类免疫缺陷病毒（HIV）阴性原发性中枢神经系统淋巴瘤（PCNSL）相对少见，而HIV阳性PCNSL的发病率在过去5年中急剧上升。在所有获得性免疫缺陷综合征（AIDS）患者中，2%至6%会临床上发生PCNSL，尸检时发现PCNSL的比例高达11%。在美国，旧金山有一些最早且最广泛的HIV阳性PCNSL治疗经验。本文报告了有和没有HIV的患者的PCNSL情况。
使用我们基于诊断的计算机检索系统，我们确定了1982年1月至1992年1月期间所有接受放疗的PCNSL患者，并查阅了他们的病历。分析了人口统计学特征、危险因素和生存时间（LOS）。统计方法包括Cox比例风险模型和Kaplan-Meier生存曲线。
确定了56例PCNSL患者，其中41例HIV阳性，15例HIV阴性。与前5年相比，1987 - 1991年期间PCNSL病例总数增加了四倍；这些病例主要在HIV阳性组。HIV阳性组的平均卡诺夫斯基功能状态评分（KPS）为50，而HIV阴性组的KPS为35。然而，HIV阳性组的中位LOS为3个月，而HIV阴性组为20个月。在每组中，KPS和LOS之间存在统计学显著相关性。
HIV相关PCNSL患者的中位LOS比无HIV的PCNSL患者短得多；然而，两组的预后都很差。需要进行随机临床试验，以确定哪些HIV患者可能从更积极的治疗中获益，并确定无HIV的PCNSL患者放化疗的最佳选择和剂量。
