Primary central nervous system lymphoma (PCNSL) is a predominantly aggressive neoplasm isolated to the central nervous system or vitreoretinal space. Bilirubin is an important biomarker reflecting hepatic function and oxidative stress status that is associated with the occurrence and development of various tumors. However, its prognostic role in PCNSL has yet to be evaluated. Therefore, we conducted a prospective–retrospective study to analyze the predictive value of serum total bilirubin (STB) in PCNSL patients. The association between the pretreatment STB and clinical outcomes in PCNSL was developed in the discovery cohort (retrospective [n = 44] and prospective [n = 45]) and validated in an independent retrospective cohort (n = 69). A generalized additive model, Kaplan–Meier curve, and Cox analysis were applied. In the discovery cohort, the STB showed a linear relationship with overall survival (OS,p= 0.011) and progression-free survival (PFS,p= 0.0476). The median STB level of 12.0 µmol/L was determined as the cutoff value to predict the clinical outcomes with area under the receiver operating characteristic curve (AUROC) values of 0.9205 and 0.8464 for OS and PFS, respectively. The median STB level resulted in similar accuracy for predicting the clinical outcomes in the validation cohort with AUROC values of 0.8857 and 0.8589 for OS and PFS, respectively. In both the discovery and validation cohorts, the Kaplan–Meier survival curve and Cox regression analysis showed that the upper median STB groups showed significantly worse OS than the lower median STB groups. In conclusion, the pretreatment STB could be considered a novel biomarker to predict the clinical outcomes in patients with PCNSL receiving high-dose methotrexate-based combination immunochemotherapy.
原发性中枢神经系统淋巴瘤（PCNSL）是一种主要局限于中枢神经系统或玻璃体视网膜空间的侵袭性肿瘤。胆红素是反映肝功能及氧化应激状态的重要生物标志物，与多种肿瘤的发生发展相关，但其在PCNSL中的预后价值尚未明确。为此，我们开展了一项前瞻性-回顾性研究，旨在分析血清总胆红素（STB）对PCNSL患者的预测价值。研究通过发现队列（回顾性队列[n=44]及前瞻性队列[n=45]）建立了治疗前STB水平与PCNSL临床结局的关联，并在独立回顾性验证队列（n=69）中进行验证。研究采用广义加性模型、Kaplan-Meier曲线及Cox回归分析。在发现队列中，STB与总生存期（OS，p=0.011）及无进展生存期（PFS，p=0.0476）呈线性相关。以12.0 µmol/L作为STB中位截断值可有效预测临床结局，其预测OS和PFS的受试者工作特征曲线下面积（AUROC）分别为0.9205和0.8464。该截断值在验证队列中同样展现出良好的预测效能，OS与PFS的AUROC值分别为0.8857和0.8589。在发现队列与验证队列中，Kaplan-Meier生存曲线及Cox回归分析均显示，STB高于中位值组患者的OS显著低于STB低于中位值组。综上所述，治疗前STB水平可作为预测接受大剂量甲氨蝶呤联合免疫化疗的PCNSL患者临床结局的新型生物标志物。
肿瘤(癌症)患者之家