Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review).
Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review).
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老年人群中原发性中枢神经系统淋巴瘤的诊断，预后和治疗（综述）。
DOI：
10.3892/ijo.2021.5180
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发表时间：
2021-03
影响因子：
5.2
通讯作者：
Zhang F
中科院分区：
文献类型：
--
作者：
Liu Y;Yao Q;Zhang F
原发性中枢神经系统淋巴瘤（PCNSL）是结外非霍奇金淋巴瘤的一种罕见亚型，与全身性弥漫性大b细胞淋巴瘤不同。PCNSL的中位诊断年龄为65岁，其发病率在老年人群中迅速上升。≥20%的PCNSL患者年龄≥80岁。值得注意的是，年龄已被确定为PCNSL的独立预后不良因素。老年患者预后较年轻患者差，医源性毒性更严重；因此，老年患者是一个独特而脆弱的治疗亚群。本文对现有文献进行综述，以提高对老年人PCNSL的流行病学、临床特点、诊断、预后和治疗的认识。值得注意的是，PCNSL在免疫功能正常的老年患者（主要是男性）中的发病率正在增加。对于CNSL的诊断，成像引导的立体定向活检被认为是金标准。当立体定向活检是不可能的或结论性的，某些生物标志物已被描述，可以帮助建立诊断。尽管存在几种预后评分系统，并且已经报道了几种PCNSL患者的预后标志物，但PCNSL在老年人中的预后非常差。此外，老年患者的治疗仍然具有挑战性；一种新型药物不太可能被用作治疗性单一疗法；然而，新药物与多药化疗的联合或与其他新药物的联合可能具有治疗潜力。
Primary central nervous system lymphoma (PCNSL) is a rare subtype of extranodal non-Hodgkin lymphoma that is unique and different from systemic diffuse large B-cell lymphomas. The median age at diagnosis of PCNSL is 65 years and its incidence is rising rapidly in the elderly population. A total of ≥20% of all patients with PCNSL are ≥80 years old. Notably, age has been identified as an independent poor prognostic factor for PCNSL. Elderly patients have an inferior prognosis to that of younger patients and are more severely affected by iatrogenic toxicity; therefore, elderly patients represent a unique and vulnerable treatment subgroup. The present review summarized the available literature to provide an improved understanding of the epidemiology, clinical characteristics, diagnosis, prognosis and management of PCNSL in the elderly population. Notably, the incidence of PCNSL in immunocompetent elderly patients, predominantly in men, is increasing. For the diagnosis of CNSL, imaging-guided stereotactic biopsy is considered the gold standard. When stereotactic biopsy is not possible or conclusive, certain biomarkers have been described that can help establish a diagnosis. PCNSL has a very poor prognosis in the elderly, even though several prognostic scoring systems exist and several prognostic markers have been reported in patients with PCNSL. Furthermore, the treatment of elderly patients remains challenging; it is unlikely that a novel agent could be used as a curative monotherapy; however, a combination of novel agents with polychemotherapy or its combination with other novel drugs may have therapeutic potential.
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