原发中枢神经系统淋巴瘤22例临床特点及预后因素分析

The clinical features and prognostic factors of 22 patients with primary central nervous system lymphoma

目的 探讨原发中枢神经系统淋巴瘤 (PCNSL)的临床特点以及预后因素的分析 ,为临床上对该疾病的诊断和治疗提供依据。方法 总结我院 1993年 1月至 2 0 0 0年 5月诊治的 2 2例PCNSL患者的临床资料 ,做一回顾性分析 ,并对各可能预后因素做单因素、多因素回归分析。结果 2 2例PCNSL中男、女各 11例 ,年龄 17～ 81岁 ,平均年龄 49 5岁。 2 2例中有效随访 2 0例 ,在随访终点存活 9例 ,死亡 11例 ,存活期 1～ 81个月 ,中位生存时间 14 5个月。并发现是否做过鞘内注射 (P =0 0 0 5 )及累及部位是局限或弥漫 (P =0 0 31)是与生存长短相关的两大预后因素。结论 PCNSL发病率仅千万分之一 ,近年来国外文献报道其发病率有增长势头。手术治疗是PCNSL的主要治疗方法。术后治疗也应当积极 ,有条件尽量实施鞘内注射 ,全身化疗是否能进一步提高生存期 ,有待于增加病例数后进一步统计分析。

Objective The authors present a retrospective analysis of 22 patients with primary central nervous system lymphoma(PCNSL) in order to provide a reasonable basis for the diagnosis and treatment of the disease. Methods This report involves a clinicopathological study of 22 patients with histologically proven PCNSL,all diagnosed between January 1993 and May 2000. Univariate and multivariate regression analysis are used to determine prognostic factors significantly associated with an unfavorable or favorable impact on survival. Results The cohort included 11 men and 11 women whose median age at diagnosis was 49.5 years. At the end point of follow up, 11 died. The median survival time for the patients in study was 14.5 months. With univariate and multivariate regression analysis, prognostic factors significantly associated with survival included intrathecal injection( P =0.005) and local/diffuse neurological deficit( P =0.031). Conclusion There continues to be a significantly increasing incidence of PCNSL. This survey throws light on the clinical and prognostic features of this uncommon disease. Through univariate and multivariate regression analysis the authors highly recommend a theraputic regime including surgery, intrathecal injection and chemotherapy, especially those drugs capable of passing blood brain barrier, for example high dose MTX.