Analysis Of The Clinical Features And Prognosis Of Primary Central Nervous System Lymphoma

Objective: Primary central nervous system lymphoma(PCNSL)is a rare malignant brain tumor,with rapid progression and poor prognosis.Recently,the incident of PCNSL has been increasing continuously.It lacks special characteristic clinical and imaging manifestations.The standard treatments are not proposed.The study aims to raise awareness of PCNSL and to provide some experience for the early diagnosis,selection of treatment and evaluation of prognosis by summarizing the clinical,imaging,pathological features of 44 patients with PCNSL.At the same time,we analyze the prognostic factors according to the above date.Methods: It was a retrospective analysis of the clinical data and the prognosis of 44 cases pathologically confirmed to be PCNSL after surgery,who were admitted to the department of neurosurgery of our hospital from January 2010 to October 2018.The characteristics of collected data were analyzed and summarized.Kaplan-Meier method and Log-rank test were used for survival analysis.Results: Among the 44 patients with PCNSL,24 were males and 20 were females,with a male to female ratio of 1.2:1,and the average age was 59.7 years and the median age was 59.5 years(range 32 to 78 years).19 cases above 60 years,25 cases below 60 years.18 cases presented with intracranial hypertension as first manifestations such as dizziness,headache,malignancy and vomiting(40.9%).12cases(27.3%)presented with partial limb weakness.The symptoms of elevated intracranial pressure were the most common initial manifestations.All patients were performed MRI scan and enhanced examination,including 34 cases with a single tumor and 10 cases with multiple tumors.All the tumors measured by imaging,most ofwhich were greater than 3cm.The lesions involved supratentorial in 37 cases,most of which were frontal lobe and temporal lobe,and 6 cases involved subtentorial,1 case involved both supratentorial and subtentorial.43 patients underwent tumor resection and 1 patient underwent stereotactic biopsy,and all the pathological results were diffuse large B-cell lymphoma.The treatment include surgery alone in 4 cases,surgery+ radiotherapy in 14 cases,surgery +chemotherapy in 16 cases,surgery +radiotherapy+ chemotherapy in 10 cases,with the median overall survival time was 30 days,506 days,582 days,943 days.The median overall survival time of the group treated with surgery alone was significantly shorter than that of other three groups(P<0.001).The median overall survival time of group treated with surgery combined with radiotherapy and chemotherapy was statistically significant longer when compare to that of the group treated with surgery combined radiotherapy or chemotherapy(P=0.030).The median overall survival time was no significant different between the group treated with surgery combined radiotherapy and the group treated with surgery combined chemotherapy(P=0.810).The median overall survival of all the patients was 586 days(14.5 months),and the longest survival time was 6 years.The 1-year,2-year and 3-ear survival rates were 74.2%,42.4%,30.2%,respectively.Univariate survival analysis showed that age(P=0.030),tumor location(P < 0.001)and preoperative Karnofsky Performance Scale(P=0.027)were prognostic factors for patients with PCNSL.Conclusion :1、The clinical manifestation of PCNSL is not obvious and specially,which is complex and diverse.Imaging manifestation have certain characteristics,which is helpful to diagnosis.The diagnosis of PCNSL depends on pathology.The pathology of PCNSL is mostly originated from B-cell lymphoma.2、The prognosis of PCNSL is related to the factor of the age,preoperative KPS,tumor location and different treatment.Age over 60 years old,KPS <70 and tumors located involved subtentorial are often poor prognostic factors.3、The median survival time of surgery combined with chemoradiotherapy is better than that of postoperative radiotherapy or chemotherapy alone.4、PCNSL has poor treatment effect.The median survival time of patients with PCNSL is short,and it is difficult to obtain a good and long survival time,so the optimal treatment for PCNSL need to be further explored and studied.