| Background and objectPrimary central nervous system lymphoma(PCNSL)is a rare subtype of highly invasive non-Hodgkin lymphoma(NHL)with extranodal locations affectings only refering to brain parenchyma,ventricle,pia mater and spinal cord.In recent years,its incidence has incressed sharply.Its clinical and imaging features are not specific and the treatment and survival of PCNSL are very different with the ordinary glioma and meningioma,so it has great clinical significance to make a correct diagnosis and classification.In this paper,we retrospectively analyze the clinical and pathological features in immunocompetent individuals to explore the possible prognostic factors.The data can be further accumulated for the diagnosis and treatment of the disease.Methods1.The clinical and pathological data of 79 patients with PCNSL diagnosed by routine staining and immunohistochemistry from June 2009 to December 2015 were collected from the Department of Pathology,the First Affiliated Hospital of Zhengzhou University.2.we collected all cases clinical information and pathological information to make a retrospective studies.3.SPSS 17.0 statistical software was used for data analysis.The overall survival was calculated from the patient's diagnosis to death or the last follow-up.Univariate analysis using Kaplan-Meier method,Log-rank test method for comparison.Multiple prognostic factors were analyzed using the COX regression model.A level of P <0.05 was considered statistically significant.Results1.There were 79 patients with PCNSL,38 males and 41 females.The age of the patients ranged from 6 to 74 years(median age: 58 years)with male-to-female ratio(1:1.1).The main clinical features of patients were neurological impairment and increased intracranial pressure.2.In this group of patients,78 cases showed a B-cell immune phenotype and 1 case showed a T-cell immune phenotype.According to the WHO classification of tumors of hematopoietic and lymphoid tissues(2008),there were 72 cases diffuse large B cell lymphoma(DLBCL),1 case Burkitt lymphoma,1 case mucosa-associated lymphoid tissue lymphoma(MALToma),1 case peripheral T cell lymphoma,not otherwise specified(PTCL-NOS),1 case of gray lymphoma between DLBCL and Burkitt lymphoma,and 3 cases of B-cell lymphoma without further classified.In this study,65 cases of DLBCL were classified based on the Hans algorithm,of which 11 cases were GCB(16.9%)and 54 case were non-GCB(83.1%).Positive staining for CD10 was seen in 3 cases(4.6%),BCL-6 in 51 cases(78.5%),MUM-1 in 52 cases(80.0%)and 39 cases(60%)coexpressed BCL-6 and MUM-1.The positive rates of BCL-2 and C-MYC were 71.1%(27/38)and 60.5%(23/38).26 patients underwent CD30 immunohistochemistry with a positive rate of 15.4%(4/26).In this study,in situ hybridizationin for EBER was performed in 14 patients,all of them were negative.3.The last follow-up date was December 31,2016,and the follow-up period was 12-90 months.Among them,26 patients had died,43 patients survived and 10 patients droped out during follow-up.Univariate analysis showed that the age,the IPI score,the LDH level and HD-MTX-based chemotherapy were releted to the prognosis(P<0.05).The number of lesions,lesions with or without deep-site involvement,?2-MG levels and immune phenotype were not statistically significant(P?0.05).In immunohistochemical markers,BCL-6 was associated with prognosis(P<0.05),while MUM-1,C-MYC,BCL-2 and CD30 were not associated with prognosis(P?0.05).Multivariate survival analysis was performed using COX regression,and the results showed that IPI score was independent prognostic risk factor(P<0.05).Conclusions1.The most common pathologic type of PCNSL was DLBCL,and mostly non-GCB origin.2.In patients with PCNSL,age ?60 years,IPI score ? 2,elevated LDH levels suggested that patients were with poor prognosis.HD-MTX-based chemotherapy could effectively improve the prognosis of patients.Immunohistochemical positive expression of BCL-6 was beneficial to the prognosis of patients. |
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