Cuny E, Loiseau H, Cohadon F
Clinique Universitaire de Neurochirurgie, Hôpital Pellegrin, Bordeaux.
Neurochirurgie. 1998 Mar;44(1):19-24.
Non-AIDS primary central nervous system lymphomas may respond totally or partially to corticosteroids. These corticoid-induced remissions seems to be very specific for this disease. They have been proposed as diagnostic test. The effect of these remissions on prognosis remains unknown.
A retrospective study was conducted. Corticosteroid sensibility, duration of survival, duration of disease free interval and type of treatment were compared between two groups of patients. The first one (group 1) included 44 patients in which exact diagnosis was made by stereotactic biopsy or surgery. The second group (group 2) included 5 patients exhibiting typical neuroradiological aspects of primary lymphoma in whom corticosteroid therapy produced a total regression of the lesions.
In group 1, 29.1% of the lymphomas exhibited cortico-sensitivity. Duration of free interval of disease accounted for 75% of the overall duration of survival. Age was the only significant factor predicting remission (p = 0.019). The sole factor influencing total duration of remission was the type of treatment (p = 0.03). Duration of remission was significantly shorter in group 2 versus group 1 patients (p = 0.007).
Duration of the first remission is of paramount importance on survival as well as the quality of first line therapy. In these conditions the absence of precise diagnosis due to corticoid-induced remissions could be dramatically deleterious.
非艾滋病相关的原发性中枢神经系统淋巴瘤可能对皮质类固醇完全或部分有反应。这些皮质类固醇诱导的缓解似乎对该疾病非常特异。它们已被提议作为诊断试验。这些缓解对预后的影响尚不清楚。
进行了一项回顾性研究。比较了两组患者的皮质类固醇敏感性、生存期、无病间期和治疗类型。第一组（第1组）包括44例通过立体定向活检或手术确诊的患者。第二组（第2组）包括5例表现出原发性淋巴瘤典型神经放射学特征的患者，皮质类固醇治疗使病变完全消退。
在第1组中，29.1%的淋巴瘤表现出皮质敏感性。无病间期占总生存期的75%。年龄是预测缓解的唯一显著因素（p = 0.019）。影响缓解总时长的唯一因素是治疗类型（p = 0.03）。第2组患者的缓解期明显短于第1组患者（p = 0.007）。
首次缓解期的时长对生存以及一线治疗质量至关重要。在这种情况下，由于皮质类固醇诱导的缓解而缺乏精确诊断可能会带来极大危害。
