| Objective:To analyze the clinical characteristics and prognostic factors of the patients diagnosed with primary CNS lymphoma in order to provide some clinical experiences in the management of this disease.Methods:Between January 2005 and December 2014,19 patients with primary CNS lymphoma who were diagnosed and treated at The First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed. The medical records were reviewed and the relevant clinical data were collected. All the patients were followed up by phone. Survival analyses of clinical outcome and possible prognostic factors such as age, performance status, the number and location of the tumor, LDH, treatment regimen were performed using SPSS 16.0.Results:(1) 19 patients, including 13 males and 6 females, were enrolled with median age of 43 years (range,22-80 years) with a total of 13 (68.42%)<60 years of age and male to female ratio is 2.2:1. Among them,3 cases could not be contacted during follow-up giving a response rate of 84.21%. The median follow-up was 11 months (range 4-83 months).(2) The most common clinical manifestations were symptoms of increased intracranial pressure (68.42%) and weakness (57.89%). The tumors were mostly located in the frontal lobe (42.11%) with multiple lesions (57.89%) as the majority.10 patients (52.63%) had an ECOG performance status of>1 at the initial presentation.18 patients (94.74%) were histologically classified as diffuse large B cell lymphoma (DLBCL). Among them,3 cases were GCB type,12 cases were Non-GCB type and the other 3 cases were unknown.(3) All the patients except one, were given surgical treatment. Among them,6 cases were treated only with surgery or biopsy, chemotherapy was offered in 5 cases (26.31%) and 8 cases (42.11%) received combination chemotherapy and radiotherapy.(4) According to survival analysis, median overall survival (OS) and median progression free survival (PFS) were 17 months and 11 months respectively. 1,2,3 and 5 year-overall survival rates were 54.7%,47.9%,47.9% and 38.3% respectively, and progression free survival rates were 44.1%,37.8%,30.2% and 30.2% respectively.(5) By using Kaplan-Meier survival analysis, age<60 years and combination chemotherapy and radiotherapy were associated with improved survival (P=0.029 and P=0.003 respectively). Multivariate analysis using Cox regression model revealed that age and treatment regimens were the independent prognostic factors of PCNSL in this study (P=0.03 and P=0.016 respectively).Conclusions(1)Primary CNS lymphoma, mainly derived from B lymphocytes, is an aggressive non-Hodgkin lymphoma diagnosed by tissue biopsy. The most common clinical manifestations were symptoms of increased intracranial pressure and weakness. The tumors were mostly located in frontal lobe with multiple lesions as the majority.(2)Histopathological examination is the gold standard for accurate diagnosis of PCNSL. DLBCL was the most common type of PCNSL, accounting for 94.74% of cases. Non-GCB type was more common than GCB-type.(3)The prognosis of PCNSL remains unfavorable. The median OS was 17 months and the 5-year survival rate was 38.3% in our study.(4)Chemotherapy in combination with radiotherapy improved prognosis compared with surgery or chemotherapy alone.(5)Age and treatment regimen were the independent prognostic factors of PCNSL in this retrospective analysis. |
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