原发性中枢神经系统淋巴瘤的预后和复发模式:对 1983-2020 年间确诊的 559 例患者的纵向分析。

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY Neuro-oncology Pub Date : 2024-11-04 DOI:10.1093/neuonc/noae115
Kathryn R Tringale, Michael Scordo, Joachim Yahalom, Charlie White, Zhigang Zhang, Behroze Vachha, Gustav Cederquist, Lauren Schaff, Lisa DeAngelis, Christian Grommes, Brandon S Imber
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引用次数: 0

摘要

背景:缺乏原发性中枢神经系统淋巴瘤(PCNSL)的当代预后和复发模式。我们分析了大量随访患者中与复发相关的因素:方法:我们对1983-2020年间免疫功能正常的PCNSL(弥漫大B细胞)患者的T1后对比增强疾病进行了特征性分析。根据患者对诱导和巩固治疗的反应进行分层(完全/未确诊 [CR/CRu]、部分、稳定、进展 [POD])。难治是指在诱导期间(或复发后≤3个月)出现POD。初始复发部位分为局部(累及/邻近基线)、远处实质内、脑膜外、其他。无进展生存期(PFS)和总生存期(OS)采用比例危险法进行评估。采用竞争风险累积发生率评估局部复发情况:中位随访时间为 7.4 年(N=559)。大多数患者(321例,57%)为复发分区分析2级(年龄≥50岁,KPS≥70)。大多数患者为上脑膜(420例,81%)、多灶(274例,53%)、双侧(224例,43%)和深部结构受累(314例,56%)。几乎所有患者都接受了以甲氨蝶呤为基础的诱导治疗(532例,95%)。根据诱导的初始反应(CR/CRu 与 PR),最终达到 CR/CRu 的患者在巩固治疗后的 PFS 或 OS 方面没有差异。351名获得CR/CRu并进行巩固治疗的患者1年和5年的PFS分别为80%(95%CI:76-84%)和46%(95%CI:41-53%);局部复发与非局部复发的1年累积发生率分别为1.8%和15%。在 97 例难治性患者中,局部复发与非局部复发的 1 年累计发生率分别为 57% 与 42%。深部结构受累(HR 1.89,95%CI:1.10-3.27)与难治性患者的局部复发有关:我们首次在一个大型 PCNSL 队列中报告了全面的复发模式。结论:我们首次在大型 PCNSL 队列中报告了全面的复发模式。虽然 CR 至巩固治疗后的复发通常是远处复发且不可预测,但难治性患者的局部复发率相对较高。这些发现有助于优化这一高风险人群的多模式疗法。
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Outcomes and relapse patterns in primary central nervous system lymphoma: Longitudinal analysis of 559 patients diagnosed from 1983 to 2020.

Background: Contemporary outcomes and relapse patterns in primary CNS lymphoma (PCNSL) are lacking. We analyzed factors associated with relapse in a large cohort with extensive follow-up.

Methods: T1-post-contrast-enhancing disease was characterized in immunocompetent PCNSL (diffuse large B-cell) patients from 1983 to 2020. Patients were stratified by response to induction and consolidation (complete/unconfirmed [CR/CRu], partial, stable, progression [POD]). Refractory was POD during (or relapse ≤3 months of) induction. Initial relapse site was categorized as local (involving/adjacent to baseline), distant intraparenchymal, leptomeningeal, or other. Progression-free (PFS) and overall survival (OS) were assessed with proportional hazards. Cumulative incidence with competing risks was used to assess local relapse.

Results: Median follow-up was 7.4 years (N = 559). Most (321, 57%) were recursive partitioning analysis class 2 (age ≥50, Karnosfky Performance Status [KPS] ≥70). Most had supratentorial (420, 81%), multifocal (274, 53%), bilateral (224, 43%), and deep structure involvement (314, 56%). Nearly all received methotrexate-based induction (532, 95%). There was no difference in PFS or OS from consolidation based on initial response to induction (CR/CRu vs PR) in patients who ultimately achieved a CR/CRu to consolidation. PFS at 1-, 5 years for 351 patients with CR/CRu to consolidation was 80% (95% confidence interval [95% CI]: 76%-84%) and 46% (95% CI: 41%-53%), respectively; 1-year cumulative incidence of local versus nonlocal relapse was 1.8% versus 15%, respectively. For 97 refractory patients, 1-year cumulative incidence of local versus nonlocal relapse was 57% versus 42%, respectively. Deep structure involvement (HR 1.89, 95% CI: 1.10%-3.27%) was associated with local relapse in refractory patients.

Conclusions: We report the first comprehensive relapse patterns in a large PCNSL cohort. While relapses post-CR to consolidation are typically distant and unpredictable, refractory patients had a relatively high incidence of local relapse. These findings can help optimize multimodality therapy for this highest-risk population.

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来源期刊
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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