Evaluation of Memorial Sloan‐Kettering Cancer Center and International Extranodal Lymphoma Study Group prognostic scoring systems to predict Overall Survival in intracranial Primary CNS lymphoma

Abstract

ObjectivesTo evaluate the validity of Memorial Sloan‐Kettering Cancer Center (MSKCC) and International Extranodal Lymphoma Study Group (IELSG) prognostic scoring systems for Overall Survival (OS) in intracranial Primary CNS lymphoma (PCNSL) of all patients diagnosed at a single center.Material and MethodsPretreatment clinical factors including tumor characteristics and histology, treatment, and survival of PCNSL patients with diagnostic biopsies over a 12‐year period (2003–2014) were retrieved from a prospective database at Oslo University Hospital.ResultsSeventy‐nine patients with intracranial PCNSL were identified. The female:male ratio was 1:1.63 and the median age was 65.3 years [range 18.9–80.7]. Involvement of deep brain structures was shown in 63 patients. Six patients were MSKCC risk group 1, 35 patients were in risk group 2, and 38 patients were in risk group 3. International Extranodal Lymphoma Study Group scores were <2 in 17 patients (22%). After a median follow‐up of 70.5 months, 55 patients were dead. Median OS was 16.4 months [range 0.2–157.7]. Age, sLDH by recursive partitioning analysis (RPA), Eastern Cooperative Oncology Group score (ECOG), lesion size, involvement of deep brain structures, IELSG score, and MSKCC score were significant factors for OS in univariate analysis. Multivariate analysis confirmed the significance of age (p < .05), sLDH by RPA (p < .005), ECOG (p < .05), and deep brain structure involvement (p < .05) for OS. The six‐tiered IELSG scores had to be dichotomized according to RPA analysis into <2 and ≥2 in order to have prognostic value. In contrast, when using the three‐tiered MSKCC, three distinct risk groups were identified.ConclusionsOur study failed to verify the IELSG, but validated the use of MSKCC for prognostication of OS in intracranial PCNSL.

A new prognostic score for disease progression and mortality in patients with newly diagnosed primary CNS lymphoma

“…The effect of PS on estimating OS was thus outweighed by the effect of age and deep brain involvement in the multivariate analysis. In terms of deep brain involvement, both earlier and recent findings concurred with ours that deep structure involvement is correlated with both OS and PFS independently …”

“…PCNSL patients often exhibit elevated intracranial pressure due to brain lesions accompanied by perifocal edema, which thereby prohibits routine lumbar puncture before the commencement of treatment. Indeed, there is a high percentage of missing values regarding this variable in the original IELSG study and many subsequent retrospective cohorts, leading to the failure of assigning a complete IELSG score . On the contrary, the Taipei Score is based on only three variables, namely, age, PS and tumor location, which are easily and regularly obtainable in clinical practice, therefore making it an amenable model for clinical use.…”

“…Although the IELSG model was established based on a relatively large sample of patients (n = 378) from multiple centers, two‐thirds of the samples lacked data on LDH level or CSF protein. Information regarding LDH level or CSF protein was not always obtainable in the clinical practice, making the application and validation of IELSG difficult in many previous studies . The second model is a three‐factor scoring system developed by researchers in Nottingham and Barcelona, consisting of age, PS, presence of multifocal lesions or meningeal disease .…”

Sex-Specific Differences in Primary CNS Lymphoma

“…The risk factors for poor outcomes include impaired immune status, increased patient age, poor clinical performance, and the non-receipt or failure of first-line chemotherapy [ 20 , 21 , 22 , 23 , 24 , 25 ]. In addition, a negative prognostic role has been postulated for the involvement of deep brain structures [ 24 , 25 , 26 ].…”

“…The risk factors for poor outcomes include impaired immune status, increased patient age, poor clinical performance, and the non-receipt or failure of first-line chemotherapy [ 20 , 21 , 22 , 23 , 24 , 25 ]. In addition, a negative prognostic role has been postulated for the involvement of deep brain structures [ 24 , 25 , 26 ]. In contrast, analyses of tumor-infiltrating lymphocytes (TILs) and tumor-associated macrophages (TAMs) have yielded controversial or inconclusive results [ 27 , 28 , 29 , 30 , 31 , 32 ] and were found to differ between CNS and non-CNS lymphoma [ 33 , 34 ].…”