30例原发性中枢神经系统淋巴瘤患者的临床特征及预后分析  

Clinical and prognostic analysis of 30 cases of primary central nervous system lymphoma

作　　者：佘春华[1,2,3] 谈丽彩 李鹏 马莉[1,2,3] 李文良 

机构地区：[1]天津医科大学肿瘤医院神经外科/神经肿瘤科 [2]国家肿瘤临床医学研究中心 [3]天津市“肿瘤防治”重点实验室,300060

出　　处：《中华血液学杂志》2015年第4期282-285,共4页Chinese Journal of Hematology

基　　金：基金项目：天津医科大学肿瘤医院引进人才与博士启动基金（B1318）

摘　　要：目的探讨原发性中枢神经系统淋巴瘤（PCNSL）的临床特征、治疗及预后相关因素。方法回顾性分析2006年2月至2014年3月天津医科大学肿瘤医院收治的30例PCNSL患者的临床资料，采用Kaplan—Meier法及Log—rank检验进行生存分析。结果30例患者中男14例，女16例，平均年龄57．4（23-81）岁。单发肿瘤18例，多发肿瘤12例。17例主要表现高颅压症状，13例表现为不同程度的局灶性神经系统损害。弥漫大B细胞淋巴瘤13例。60％以上患者接受手术、放疗及化疗联合治疗。所有患者治疗后评价CR率63．3％，中位生存期为24个月，2年生存率为46．7％，5年生存率为13．3％，6个月无进展生存率60．O％，1年无进展生存率为43．3％。其中11例患者接受全脑放疗联合化疗，中位生存期为48个月，7例患者接受立体定向放射外科联合化疗，中位生存期与前者比较差异无统计学意义（P=0．233）。单因素生存分析提示年龄与生存期相关（P=0．030）。结论PCNSL以弥漫大B细胞淋巴瘤多见，可表现为单发或多发，临床表现为颅内高压或局部神经系统损害。年龄是生存期的重要相关因素。手术治疗适用于幕上、位置表浅肿瘤及急性高颅压患者。立体定向放射外科治疗可迅速缓解症状，神经毒性小，是可行的局部治疗手段。多模式治疗的结合更能使患者获益。Objective To explore clinical characteristics, treatment and prognosis of primary central nervous system lymphoma（PCNSL）. Methods Retrospective analysis, Kaplan-Meier analysis and Log-rank test were conducted on 30 PCNSL patients from 2006 to 2014 in our hospital. Results The median age of this cohort （14 males and 16 females） was 57.4 years old. 18 cases had single tumor, 12 cases multiple. 17 cases presentd with intracranial hypertension and 13 cases focal neurological deficits. 13 cases （62%） were diffuse large B cell lymphoma. About 60% patients received combination therapy including surgery, radiotherapy or chemotherapy. 63.3% complete remission rate （CR） was achieved for all patients. Kaplan-Meier analysis and Log-rank test showed the median overall survival （OS） was 24 months, the rates of 2-year survival, 5-year survival, 6-month progression-flee survival （PFS） and 1-year free-progressed survival （PFS） were as of 46.7%, 13.3%, 60.0% and 43.3% respectively. The median OS of 11 patients received whole brain radiotherapy （WBRT）combined with chemotherapy was 48 months. The median OS of 7 patients treated with stereotactie radiosurgery （SRS） combined with chemotherapy had no significant difference when compared to the former （P=0.233）. Survive analysis showed that age was prognostic factor for PCNSL patients （P=0.030）. Conclusions Diffuse large B cell lymphoma was the main type of PCNSL, single or multiple location, presented with increased intracranial hypertension or focal neurological deficits. Age was the key prognostic factor for patients. Surgery was suitable for patients with supertentorial and superficial tumor or with acute intracranial hypertension syndrome. SRS was a feasible local therapy which alleviated the symptoms and led to less toxicity. PCNSL patients mightbenefit from multimode therapy.

关 键 词：淋巴瘤 中枢神经系统 原发性 甲氨蝶呤 手术 立体定向放射外科治疗 治疗结果 

分 类 号：R739.4[医药卫生—肿瘤]