复发/难治性原发性中枢神经系统淋巴瘤挽救性全颅放疗和化疗的疗效比较及预后因素分析  

Efficacy and prognostic analyses of salvage WBRT and chemotherapy in relapsed/refractory primary central nervous system lymphoma

作　　者：杨宇 林之光 马晶晶 康惠 李情 张梦雪 马燕 陈波斌 YANG Yu;LIN Zhi-guang;MA Jing-jing;KANG Hui;LI Qing;ZHANG Meng-xue;MA Yan;CHEN Bo-bin(Department of Hematology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院血液科,上海200040

出　　处：《复旦学报（医学版）》2023年第2期166-174,共9页Fudan University Journal of Medical Sciences

基　　金：上海申康医院发展中心临床三年行动计划(SHDC2020CR6005-002)。

摘　　要：目的比较全颅放疗(whole brain radiotherapy,WBRT)与其他挽救性治疗方案在复发/难治性原发性中枢神经系统淋巴瘤(relapsed/refractory primary central nervous system lymphoma,R/R PCNSL)中的疗效,并进行预后因素分析。方法采用回顾性队列研究,统计2016年1月至2020年12月复旦大学附属华山医院收治的初次R/R PCNSL患者相关资料,对接受含或不含WBRT挽救治疗的患者进行生存与预后相关因素的统计学分析。结果共纳入104例患者,37例接受WBRT治疗(WBRT组),67例仅接受单纯化疗(非WBRT组)。WBRT组与非WBRT组的客观反应率(objective response rate,ORR)分别为70.6%和29.2%,差异有统计学意义(P<0.01)。WBRT组中位无进展生存期(progression-free survival,PFS)6.1个月,非WBRT组中位PFS 2.0个月,差异有统计学意义(P<0.01)。WBRT组中位总生存期(overall survival,OS)28.8个月,非WBRT组中位OS 30.2个月,差异无统计学意义(P>0.05)。预后单因素与多因素分析显示,脑脊液(cerebral spinal fluid,CSF)蛋白水平和挽救治疗反应与PFS有关,KPS评分和挽救治疗反应与OS有关。结论可以推荐WBRT作为初次R/R PCNSL的早期挽救治疗方法,相比化疗能获得更佳的PFS和应答率,但未见OS的明显获益。脑脊液蛋白>0.45 g/L、挽救治疗3个疗程内未达到部分缓解(partial remission,PR)是对预后不利的独立危险因素。Objective To evaluate the efficacy of salvage therapeutic strategy with or without whole brain radiotherapy(WBRT)and analyze potential factors involving with prognosis in relapsed/refractory primary central nervous system lymphoma(R/R PCNSL).Methods Data from patients with the first time R/R PCNSL diagnosed at our institution between Jan 2016 to Dec 2020 were retrospectively analyzed.Patients receiving salvage treatment with or without WBRT were analyzed for survival and prognostic factors.Results A total of 104 patients were recruited including 37 patients treated with WBRT(WBRT group)and 67 patients with chemotherapy only(non-WBRT,nWBRT group).Objective response rate(ORR)was 70.6%in WBRT group and 29.2%in nWBRT group(P<0.01).In WBRT group and nWBRT group,median progression-free survival(PFS)was 6.1 months and 2.0 months(P<0.01),and median overall survival(OS)was 28.8 months and 30.2 months(P>0.05),respectively.Univariate and multivariate analysis showed that higher level of cerebral spinal fluid(CSF)protein and response to salvage therapy were related to PFS,while KPS score and response to salvage therapy were related to OS.Conclusion WBRT may be recommended as salvage treatment for the first time R/R PCNSL patients,which brought longer PFS and higher response rate but no benefit on OS compared with chemotherapy.CSF protein>0.45 g/L and failed to achieve PR within 3 courses of salvage therapy were independent unfavorable prognostic factors of R/R PCNSL.

关 键 词：复发/难治性原发性中枢神经系统淋巴瘤(R/R PCNSL) 全颅放疗(WBRT) 化疗 疗效 预后 

分 类 号：R733[医药卫生—肿瘤] R45[医药卫生—临床医学]