原发性中枢神经系统淋巴瘤患者的临床特点与预后分析

Clinical Characteristics and Prognosis of Patients with Primary Central Nervous System Lymphoma

目的探讨原发性中枢神经系统淋巴瘤的临床表现、病理学特征、治疗方法和预后。方法对38例经病理证实的原发性中枢神经系统淋巴瘤患者的临床特征、病理学特征、治疗方法及预后情况进行回顾性分析。结果 38例患者临床症状主要表现为头晕、头痛、肢体活动障碍、记忆力减退;临床诊断方法中,立体定向活检29例、开颅活检8例、神经内镜活检1例;38例患者病理类型均为弥漫大B细胞淋巴瘤,免疫组化结果为Pax-5阳性36例,CD20阳性34例,MUM1阳性27例,CD10阴性26例,CK阴性29例;随访25例,接受放化疗患者的生存时间(39.6个月)与未接受放化疗患者(7.2个月)有统计学差异(P <0.05)。结论原发性中枢神经系统淋巴瘤是神经系统的少见肿瘤,目前推荐立体定向活检确诊后,应用大剂量甲氨蝶呤为基础的联合化疗并辅以全脑放疗或干细胞移植的治疗方案,总体治疗效果较既往有所提高。

Objective To explore the clinical and pathological characteristics, treatment, and patient prognosis of primary central nervous system lymphoma. Methods The clinical and pathological features, treatment methods, and prognosis of 38 patients with pathologically confirmed primary central nervous system lymphoma were analyzed retrospectively. Results Of the total 38 patients, 29 were confirmed by stereotactic biopsy, 8 by open biopsy, and 1 by neuroendoscopic biopsy. The clinical manifestations included head- ache, paralysis, dizziness, and forgetfulness. The pathologic examination showed 38 cases of diffuse large B cell lymphoma. There were 36 Pax-5-positive cases, 34 cluster of differentiation( CD) 20-positive cases, 27 MUM1-positive cases, 26 CD10-negative cases, and 29 CK-negative cases. Twenty-five patients underwent follow-up;patients who received radiochemotherapy( 39.6 months) had a longer OS than that in patients who did not receive radiochemotherapy( 7.2 months, P < 0.05). Conclusion Primary central nervous system lym- phoma is a relatively rare intracranial malignant tumor. The diagnosis relies on brain biopsy, especially stereotactic biopsy. The foundation of treatment is high-dose methotrexate-based induction chemotherapy in combination with additional consolidative chemotherapy, whole- brain radiation, or stem cell transplantation. In general, the therapeutic effect was improved.