75例原发中枢神经系统淋巴瘤临床分析

Clinical analysis of 75 cases with primary central nervous system lymphoma

目的:探讨原发中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)的临床特征、治疗方案及预后相关因素。方法:回顾性分析2011年11月至2015年11月郑州大学第一附属医院收治的75例免疫功能正常的PCNSL患者临床资料。采用K-M法及Cox多因素回归模型进行生存资料分析。结果:75例PCNSL患者中位发病年龄为55(9~79)岁,男女比为1.1∶1。颅内压增高及局灶性神经系统损害为主要表现。病理类型均为弥漫大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)。随访到69例,其中术后放化疗联合组25例、术后化疗组28例、术后放疗组9例及单纯手术治疗组7例。中位无进展生存期(median overall progression-free survival,m PFS)分别为23.6(95%CI:16.0~31.3)、6.4(1.0~11.8)、9.8(4.7~14.9)和5.0(4.9~5.2)个月,中位总生存期(median overall survival,m OS)分别为45.7(95%CI:44.2~47.2)、11.0(7.1~15.0)、16.1(15.3~17.0)和6.9(1.9~12.0)个月,差异均具有统计学意义(P<0.01)。单因素及多因素分析均表明发病年龄及东部肿瘤协作组体力状况评分(ECOG)与生存期相关。结论:PCNSL多发于中老年人,类型以DLBCL多见,临床表现以颅内压增高和局灶性神经系统损害为主。年龄≤60岁、ECOG评分≤1分的患者预后较好。术后行放化疗治疗可显著提高患者生存期。

Objective： To investigate the treatment, clinical characteristics, and outcomes of patients with primary central nervous system lymphoma （PCNSL）. Methods： A total of 75 patients histologically confirmed with PCNSL from November 2011 to November 2015 in the frist affiliated hospital of Zhengzhou Unversity were enrolled in this retrospective study. The clinical characteristics, treatment outcomes and prognostic factors of the patients were analyzed, The Kaplan-Meier method was used for univariate analysis of survival, with assessment of differences by the Log-rank test. Multivariate analysis was performed using the Cox proportional hazards model. Results： The median age at diagnosis of the 75 patients with PCNSL was 55 years （range： 9-79 years）, and a male-to-female ratio of 1.1： I was observed. Major clinical characteristics observed in the patients were increased intracranial pressure and focal neurological deficits. All patients were diagnosed with diffuse large B-cell lymphoma （DLBCL）. Of the 69 patients with follow-up data, the median progression-free survival （PFS） of the chemotherapy combined with radiotherapy group （n=25）, chemotherapy group （n=28）, radiotherapy group （n=9） and surgery group （n=7） were 23.6 （95% Ch 16.0-31.3）, 6.4 （1.0-11.8）, 9.8 （4.7-14.9）, and 5.0 （4.9-5.2） months, respectively. The median overall survival （OS） of these four groups was 45.7 （95% Ch 44.2-47.2）, 11.0 （7.1-15.0）, 16.1 （15.3-17.0）, and 6.9 （1.9- 12.0） months, respectively. All differences in PFS and OS between the groups were statistically significant （all P〈0.01）. No statistical dif- ferences were observed in the incidence of treatment-induced toxicity among these groups （P〉0.05）. Survival analysis showed that both age and Eastern Cooperative Oncology Group （ECOG） performance status were significantly associated with OS, and thus were independent risk factors. Conclusions： PCNSL predominantly occurred in elderly people. Diffuse large B-cell lymphoma was the main type of PCNSL diagnosed. Increased intracranial pressure and focal neurological deficits were the major clinical characteristics of the patients. Age （60 years or younger）, ECOG performance status score≤1, and the comprehensive treatment modality were significantly associated with improved OS.