Background: Central nervous system lymphoma (CNSL) is rare form of brain tumour. It manifests either as primary CNS lymphoma (pCNSL) originating within the central nervous system or as secondary CNS lymphoma (sCNSL), arising as cerebral metastases of systemic lymphoma. For a significant period, surgical resection was considered obsolete due to the favourable response to chemotherapy and the associated risk of postoperative deficits. The objective of the present study was to demonstrate the benefits of resection in CNSL patients, including extended survival and improved postoperative function. Methods: A retrospective study involving patients diagnosed with either PCNSL or SCNSL that were surgically approached at our neurosurgical department between 2010 and 2022 was conducted. Patients were categorised into three subgroups based on their neurosurgical approach: (1) stereotactical biopsy, (2) open biopsy, (3) resection. We then performed statistical analyses to assess overall survival (OS) and progression-free survival (PFS). Additionally, we examined various secondary factors such as functional outcome via Karnofsky Performance Index (KPS) and prognosis scoring. Results: 157 patients diagnosed with PCNSL or SCNSL were enclosed in the study. Of these, 101 underwent stereotactic biopsy, 21 had open biopsy, and 35 underwent resection. Mean age of the cohort was 64.94 years, with majority of patients being female (54.1%). The resection group showed longest OS at 44 months (open biopsy = 13 months, stereotactic biopsy = 9 months). Calculated median follow-up was 34.5 months. In the Cox regression model, postoperative KPS 70% (p< 0.001) and resection vs. stereotactic biopsy (p= 0.040) were identified as protective factors, whereas older age at diagnosis was identified as a risk factor (p< 0.001). In the one-way analysis of variance, differences in postoperative KPS were found among all groups (p= 0.021), while there was no difference in preoperative KPS among the groups. Conclusions: Our data show a favourable outcome when resection is compared to either stereotactic or open biopsy. Additionally, the marginally improved postoperative functional status observed in patients who underwent resection, as opposed to in those who underwent biopsy, provides further evidence in favour of the advantages of surgical resection for enhancing neurological deficits.
背景：中枢神经系统淋巴瘤（CNSL）是一种罕见的脑肿瘤，可表现为原发于中枢神经系统的原发性中枢神经系统淋巴瘤（pCNSL），或作为系统性淋巴瘤脑转移的继发性中枢神经系统淋巴瘤（sCNSL）。在相当长的一段时间内，由于化疗反应良好且存在术后功能缺损风险，手术切除曾被认为过时。本研究旨在论证CNSL患者接受切除术的益处，包括延长生存期和改善术后功能。 方法：本研究回顾性分析了2010年至2022年间在我院神经外科接受手术治疗的PCNSL或SCNSL患者。根据神经外科手术方式将患者分为三组：（1）立体定向活检，（2）开放活检，（3）切除术。随后进行统计分析以评估总生存期（OS）和无进展生存期（PFS）。此外，我们还通过卡氏功能状态评分（KPS）和预后评分等指标评估了功能结果等多种次要因素。 结果：研究共纳入157例诊断为PCNSL或SCNSL的患者。其中，101例接受立体定向活检，21例接受开放活检，35例接受切除术。患者平均年龄为64.94岁，女性占多数（54.1%）。切除术组的中位OS最长，为44个月（开放活检组13个月，立体定向活检组9个月）。计算得出的中位随访时间为34.5个月。在Cox回归模型中，术后KPS≥70%（p<0.001）以及切除术（相较于立体定向活检，p=0.040）被确定为保护性因素，而诊断时年龄较大则被确定为风险因素（p<0.001）。在单因素方差分析中，各组间术后KPS存在差异（p=0.021），而术前KPS在各组间无差异。 结论：我们的数据显示，与立体定向活检或开放活检相比，切除术具有更优的预后结果。此外，接受切除术的患者术后功能状态较接受活检者略有改善，这进一步证明了手术切除在改善神经功能缺损方面的优势。
肿瘤(癌症)患者之家