初治原发性中枢神经系统淋巴瘤临床特征及预后的多中心、回顾性研究  

Clinical characteristics and prognosis of newly-treated patients with primary central nervous system lymphoma:a multicenter retrospective study

作　　者：梁新悦 闫玉蓉 黄文荣 苏文佳 亓姝楠 汤大北[5] 刘雪莲[1] 郭强[1] 孙璐[6] 李蕴潜[7] 张清媛[5] 靳凤艳[1] Liang Xinyue;Yan Yurong;Huang Wenrong;Su Wenjia;Qi Shunan;Tang Dabei;Liu Xuelian;Guo Qiang;Sun Lu;Li Yunqian;Zhang Qingyuan;Jin Fengyan(Department of Hematology,the First Hospital of Jilin University,Changchun 130021,China;Department of Lymphoma&Plasma Cell Disease,Division of Hematology Medicine,the Fifth Medical Center of Chinese PLA General Hospital,Beijing 100071,China;Department of Hematology,the First Affiliated Clinical Medical College of Harbin Medical University,Harbin 150001,China;Department of Radiation Oncology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China;Department of Internal Medicine 3,Harbin Medical University Cancer Hospital,Harbin 150080,China;Department of Pathology,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Neurosurgery,the First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学白求恩第一医院血液科,长春130021 [2]解放军总医院第五医学中心血液病医学部淋巴瘤-浆细胞疾病科,北京100071 [3]哈尔滨医科大学附属第一临床医学院血液科,哈尔滨150001 [4]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021 [5]哈尔滨医科大学附属肿瘤医院内三科,哈尔滨150080 [6]解放军总医院第一医学中心病理科,北京100853 [7]吉林大学白求恩第一医院神经肿瘤外科,长春130021

出　　处：《白血病．淋巴瘤》2023年第8期465-472,共8页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金(81670190);吉林省自然科学基金(20200201309JC);吉林省中青年科技创新创业卓越人才(团队)项目(创新类)(20210509010RQ);吉林大学"学科交叉融合创新"项目(2021)。

摘　　要：目的探讨初治原发性中枢神经系统淋巴瘤(PCNSL)的临床特征、治疗及预后。方法回顾性分析吉林大学白求恩第一医院、解放军总医院第五医学中心、哈尔滨医科大学附属肿瘤医院和中国医学科学院北京协和医学院肿瘤医院2009年8月至2018年2月收治的117例初治PCNSL患者的临床资料。对患者年龄、性别、美国东部肿瘤协作组(ECOG)体能状态(PS)评分、病理类型、是否累及深部脑组织、病灶数量、脑脊液蛋白浓度、国际结外淋巴瘤研究组(IELSG)评分、美国纪念斯隆-凯特琳癌症中心(MSKCC)评分、治疗策略、一线治疗后疗效等进行单因素及多因素Cox比例风险模型分析,以确定PCNSL患者无进展生存(PFS)和总生存(OS)的独立影响因素。采用Kaplan-Meier法进行生存分析。结果117例初治PCNSL患者中,59例(50.4%)首发症状为高颅压症状或局灶性神经症状;单发病灶65例(55.6%),多发病灶52例(44.4%);1例(0.9%)为T细胞来源,其余116例(99.1%)均为弥漫大B细胞淋巴瘤(DLBCL)。可进行疗效评价的95例患者中,完全缓解(CR)41例(43.2%),部分缓解(PR)20例(21.1%),疾病稳定(SD)16例(16.8%),疾病进展(PD)18例(18.9%)。117例患者中位随访66.0个月(95%CI 57.9~74.1个月),中位PFS时间和中位OS时间分别为17.4个月(95%CI 11.5~23.3个月)和45.6个月(95%CI 20.1~71.1个月),2、3、5年PFS率分别为41.2%、28.6%和19.3%,OS率分别为63.7%、52.4%和46.3%。单因素Cox回归分析显示,初诊时MSKCC评分高危组是PFS的不良预后因素(P=0.037),一线化疗采用≥4个周期大剂量甲氨蝶呤(HDMTX)、HDMTX联合利妥昔单抗、≥4个周期利妥昔单抗联合HDMTX、一线治疗后达CR或达≥PR降低疾病进展风险,延长PFS时间(均P<0.01);年龄>60岁、ECOG-PS评分2~4分、脑脊液蛋白浓度升高、IELSG评分高危组和MSKCC评分高危组是OS的不良预后因素,≥4个周期HDMTX、一线治疗后达CR或达≥PR为OS的保护因素。多因素Cox回归分�Objective To investigate the clinical characteristics,treatment and prognosis of newly-treated patients with primary central nervous system lymphoma(PCNSL).Methods Clinical data of 117 newly-treated PCNSL patients who were admitted to the First Hospital of Jilin University,the Fifth Medical Center of Chinese PLA General Hospital,Harbin Medical University Cancer Hospital,and Cancer Hospital of Chinese Academy of Medical Sciences&Peking Union Medical College from August 2009 to February 2018 were retrospectively analyzed.The patients'age,sex,Eastern Cooperative Oncology Group(ECOG)physical status(PS)score,pathological type,involvement of deep brain tissue,number of lesions,cerebrospinal fluid protein concentration,International Extranodal Lymphoma Study Group(IELSG)score,Memorial Sloan Kettering Cancer Center(MSKCC)score,treatment strategy,and response after the first-line therapy were analyzed using univariate and multivariate Cox proportional hazards models to identify the independent influencing factors for progression-free survival(PFS)and overall survival(OS)of PCNSL patients.Kaplan-Meier method was used for survival analysis.Results In 117 newly-treated PCNSL patients,59 cases(50.4%)presented with increased intracranial pressure or focal neurological symptoms at diagnosis;there were 65 cases(55.6%)with single lesions and 52 cases(44.4%)with multiple lesions;1 patient(0.9%)had lymphoma of T-cell origin,and 116 cases(99.1%)had diffuse large B-cell lymphoma(DLBCL).Among 95 evaluable patients,41 patients(43.2%)achieved complete remission(CR),20 patients(21.1%)achieved partial remission(PR),16 patients(16.8%)achieved stable disease(SD),and 18 patients(18.9%)had progressive disease(PD).In 117 patients with median follow-up of 66.0 months(95%CI 57.9-74.1 months),the median PFS and OS were 17.4 months(95%CI 11.5-23.3 months)and 45.6 months(95%CI 20.1-71.1 months),respectively.The 2-,3-and 5-year PFS rates were 41.2%,28.6%and 19.3%,and OS rates were 63.7%,52.4%and 46.3%,respectively.Univariate Cox regression analysis

关 键 词：中枢神经系统肿瘤 淋巴瘤 预后 

分 类 号：R739.4[医药卫生—肿瘤]