Introduction: Treatment for primary central nervous system lymphoma (PCNSL) includes high-dose methotrexate (HD-MTX)-based systemic therapy. Multiple regimens exist with no clear standard of care. We evaluated the impact of different therapies on PCNSL outcomes at a single institution.Materials and Methods: A total of 95 consecutive patients with PCNSL from 2002 to 2021 were retrospectively reviewed. The overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan–Meier method. The log-rank test and univariate and multivariable Cox regression analysis were used to evaluate the relationship between clinicopathologic and treatment variables with outcomes.Results: Among the 62 patients treated with definitive systemic therapy, the median age was 58; 71% had a Karnofsky performance status > 70, 49% had a single lesion, 31% received HD-MTX alone, and 61% had HD-MTX + rituximab. The two-year OS and PFS were 64% (95% CI: 49.8–75.0%) and 49% (95% CI: 35.0–60.9%), respectively. On multivariable analysis, the completion of > six cycles of HD-MTX (HR 0.40; 95% CI: 0.21–0.76;p= 0.01) was associated with superior OS, while the use of rituximab was associated with inferior OS (HR 2.82; 95% CI: 1.37–5.83;p= 0.01). There were no significant associations between the OS and PFS with temozolomide, the extent of surgical resection, radiation, or the size or number of initial lesions (allp> 0.05).Discussion: Innovation is needed to improve the outcomes for patients with PCNSL.
引言：原发性中枢神经系统淋巴瘤（PCNSL）的治疗包括基于大剂量甲氨蝶呤（HD-MTX）的系统性治疗。目前存在多种治疗方案，但尚无明确的标准疗法。本研究旨在评估单一机构内不同疗法对PCNSL患者预后的影响。 材料与方法：回顾性分析了2002年至2021年间连续收治的95例PCNSL患者。采用Kaplan-Meier法评估总生存期（OS）和无进展生存期（PFS）。使用对数秩检验以及单变量和多变量Cox回归分析，评估临床病理特征、治疗变量与预后之间的关系。 结果：在接受确定性系统性治疗的62例患者中，中位年龄为58岁；71%的患者卡氏功能状态评分>70，49%为单发病灶，31%接受单纯HD-MTX治疗，61%接受HD-MTX联合利妥昔单抗治疗。两年OS和PFS分别为64%（95% CI：49.8–75.0%）和49%（95% CI：35.0–60.9%）。多变量分析显示，完成超过六个周期的HD-MTX治疗（HR 0.40；95% CI：0.21–0.76；p=0.01）与更优的OS相关，而使用利妥昔单抗则与较差的OS相关（HR 2.82；95% CI：1.37–5.83；p=0.01）。OS和PFS与替莫唑胺的使用、手术切除范围、放疗、或初始病灶的大小或数量均无显著关联（所有p>0.05）。 讨论：为改善PCNSL患者的预后，需要进行治疗方案的创新。
Impact of Systemic and Radiation Therapy on Survival of Primary Central Nervous System Lymphoma
肿瘤(癌症)患者之家