The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group
The Real-World status and risk factors for a poor prognosis in elderly patients with primary central nervous system malignant lymphomas: a multicenter, retrospective cohort study of the Tohoku Brain Tumor Study Group
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DOI：
10.1007/s10147-021-02042-3
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发表时间：
2021-10-12
影响因子：
3.3
通讯作者：
Tominaga, Teiji
中科院分区：
文献类型：
--
作者：
Asano, Kenichiro;Yamashita, Yoji;Tominaga, Teiji
背景老年原发性中枢神经系统恶性淋巴瘤（EL-PCNSL）患者由于其治疗前Karnofsky Performance Status （KPS）和合并症较差，可能得不到充分的治疗。因此，我们在东北脑肿瘤研究组进行了一项回顾性队列研究，以评估与EL-PCNSL预后不良相关的危险因素。方法从8个中心选取年龄为bb0 = 71岁的PCNSL患者。采用log-rank检验进行单因素分析。采用Cox比例风险模型进行多因素分析。结果142例患者中有3例获得最佳支持治疗（BSC）。未作病理诊断者30例，经脑脊液细胞学检查者3例，经病理诊断者100例。在确认无病理治疗组和病理或脑脊液细胞学诊断组以及中位年龄>= 76岁和< 76岁之间无进展生存期（PFS）和总生存期（OS）无差异后，共研究了133例患者。治疗前KPS中位数为50%。中位PFS和中位OS分别为16个月和24个月。Cox比例风险模型分析与预后不良相关的危险因素为治疗前心血管疾病及中枢神经系统疾病合并症、治疗后肺炎及其他感染、未进行放疗或化疗。结论治疗前合并症及治疗后并发症影响预后。放疗和化疗均有效，但对于化疗的适当含量及是否需要附加放疗尚无结论。
Background Elderly patients with primary central nervous system malignant lymphoma (EL-PCNSL) may not be given sufficient treatment due to their poor pre-treatment Karnofsky Performance Status (KPS) and comorbidities. Therefore, a retrospective, cohort study was performed to evaluate risk factors associated with a poor prognosis of EL-PCNSL in the Tohoku Brain Tumor Study Group. Methods Patients aged >= 71 years with PCNSL were enrolled from eight centers. Univariate analysis was performed with the log-rank test. A Cox proportional hazards model was used for multivariate analysis. Results Three of the total 142 cases received best supportive care (BSC). Treatment was given to 30 cases without a pathological diagnosis, 3 cases with cerebrospinal fluid (CSF) cytology, and 100 cases with a pathological diagnosis. After confirmation of no differences in progression-free survival (PFS) and overall survival (OS) between the group treated without pathology and the groups diagnosed by pathology or CSF cytology and between median age >= 76 years and < 76 years, a total of 133 patients were studied. The median pre-treatment KPS was 50%. Median PFS and median OS were 16 and 24 months, respectively. Risk factors associated with poor prognosis on Cox proportional hazards model analysis were pre-treatment cardiovascular disease and central nervous system disease comorbidities, post-treatment pneumonia and other infections, and the absence of radiotherapy or chemotherapy. Conclusions Pre-treatment comorbidities and post-treatment complications would affect the prognosis. Radiation and chemotherapy were found to be effective, but no conclusions could be drawn regarding the appropriate content of chemotherapy and whether additional radiotherapy should be used.