32例原发性中枢神经系统恶性淋巴瘤临床分析及文献复习

Primary Central Nervous System Lymphoma——a Report of 32 Cases with Literature Review

背景与目的:原发性中枢神经系统淋巴瘤(primarycentralnervoussystemlymphoma,PCNSL)发病率上升且预后很差。本研究目的是探讨免疫正常的中国人PCNSL的临床特征,评价大剂量甲氨蝶呤(HD-MTX)治疗PCNSL的疗效。方法:回顾性分析经病理证实的32例(中位年龄50岁)PCNSL患者的临床资料和治疗效果。2001年11月以前采用以CHOP方案为主、单用或联合全脑放疗的治疗方法,2001年12月以后采用以HD-MTX为主、单用或联合全脑放疗的治疗方法。结果:32例PCNSL患者中25例(78.1%)45岁以上;24例(75%)主要表现为颅内高压;25例(78.1%)单发病灶;32例患者均未见脑脊液细胞学阳性表现;28例(87.5%)为B细胞淋巴瘤,其中19例为弥漫性大B细胞淋巴瘤。32例中位随访期13.5个月(1～84个月),Kaplan-Meier分析总中位生存期26个月,2年生存率45.7%;HD-MTX联合放疗组患者完全缓解率61.1%,中位生存期在26个月以上,2年生存率65.1%,疗效明显优于非HD-MTX联合放疗组;log-rank检验显示乳酸脱氢酶正常、状态评分在0～1的患者生存期较长。结论:PCNSL多发于中老年人,颅内高压为主要表现,B细胞亚型占绝对优势。HD-MTX联合全脑放射治疗PCNSL有效和可行。

BACKGROUND ＆ OBJECTIVE： The incidence of primary central nervous system lymphoma （PCNSL） is increasing, and its prognosis is poor. This study was to investigate the clinical features of PCNSL, and evaluate the efficacy of high-dose methotrexate （MTX）-based chemotherapy for immunocompetent Chinese patients with PCNSL. METHODS： Clinical data of 32 patients （median age, 50 years） with pathologically confirmed PCNSL were analyzed retrospectively. Before Nov. 2001, CHOP with or without whole brain radiotherapy （WBRT） was employed; after then, high-dose MTX-based chemotherapy with or without WBRT was employed. RESULTS： Of the 32 PCNSL patients, 25 （78.1%） were more than 45 years old; 24 （75.0%） suffered intracranial hypertension; 25 （78.1%） had single intracranial mass; no positive case of cerebrospinal fluid （CSF） cellular examination was found; 28 （87.5%） were B-cell lymphoma, among which 19 （59.4%） were diffuse large B-cell lymphoma. Median follow-up of the patients was 13.5 months （1- 84 months）. Kaplan-Meier test showed that the median overall survival time was 26 months, and the 2-year survival rate was 45.7%. The complete response rate of the 18 patients who received high-dose MTX-based chemotherapy plus WBRT was 61.1%, the median survival time was more than 26 months, and the 2-year survival rate was 65.1%. The efficacy of highdose MTX-based chemotherapy plus WBRT was better than that of CHOP plus WBRT. Log-rank test showed that the survival time of the patients with performance status （PS） of 0-1 or normal serum lactate dehydrogenase （LDH） was longer than those with PS of 2-3 or elevated LDH. CONCLUSIONS： PCNSL often occurs in middle-aged and aged patients, with intracranial hypertension as the main clinical manifestation. B-cell lymphoma is the predominant subtype. High-dose MTX-based chemotherapy plus WBRT is efficient and feasible for PCNSL.