Prognostic Factors and Survival in Primary Central Nervous System Lymphoma: A Population-Based Study

Abstract

Objective This study sought to explore the prognostic factors in a large retrospective cohort of patients with primary central nervous system lymphoma (PCNSL) from the Surveillance, Epidemiology, and End Results database. Methods There were 5903 patients with PCNSL who had complete clinical information and were identified in the Surveillance, Epidemiology, and End Results program between 1973 and 2014. The epidemiology, therapeutic measures, and clinical characteristics were listed as descriptive statistics. They were grouped into 4 categories: immunocompetent individual with diffuse large B cell lymphoma (DLBCL), immunocompetent individual with non-DLBCL, immunocompromised individual with DLBCL, and immunocompromised individual with non-DLBCL based on different subtypes and immunological status. Survival analysis was conducted with Cox regression models. Results Different demographics and clinical characteristics were identified as independent factors in different groups. In survival analysis, for patients with DLBCL, chemotherapy involving treatments was associated with the most favorable survival. Received-only radiation could be considered as a primary treatment in immunocompetent patients with non-DLBCL. These differences were statistically significant (P < 0.05). Conclusion PCNSL patients treated with appropriate chemotherapy treatments may receive stable tumor control.

Changing Incidence and Survival of Primary Central Nervous System Lymphoma in Australia: A 33-Year National Population-Based Study

“…Blood–brain and blood–tumor barriers limit penetration of drugs into the CNS compartment [ 46 ], and divergent cell-of-origin within the DLBCL group impacts responses to therapeutics [ 36 , 41 ]. Our data support the premise that there is prognostic value in considering PCNSL survival outcomes based on histopathological type, specifically DLBCL versus non-DLBCL [ 6 , 47 , 48 ].…”

“…Currently in Australia, 72.5% of PCNSL are classified as DLBCL. Studies from Western Europe and North America have reported prevalence rates of CNS DLBCL that range from 51% to 86% in predominantly immunocompetent populations [ 3 , 6 , 9 , 12 , 27 , 29 , 31 ]. Dichotomizing our data by DLBCL and non-DLBCL types showed an effect of the DLBCL diagnosis on PCNSL incidence that was masked when all histopathological types were considered together: although incidence of PCNSL appeared to be plateauing, this figure was rising for DLBCL, while decreasing for non-DLBCL.…”

“…Considering deaths from all causes, we calculated survival outcomes for patients with PCNSL, including CNS DLBCL, that are consistent with similar longitudinal reports from other high-income countries [ 10 , 11 , 30 ], including no differences between sexes, worsening prognosis with advancing age at diagnosis, and improvement in survival expectation over time. An increase in overall and 5-year survival, and median days of survival, has been associated with advances in therapeutic interventions [ 6 , 30 ]. Over the past two decades, diagnostic and treatment regimens have been developed to target molecular variations in lymphoma—particularly in DLBCL types—producing clinical benefit [ 37 , 38 , 39 , 40 , 41 , 42 , 43 ].…”

“…Despite considerable advances in the treatments for lymphoma overall, clinical outcomes of PCNSL remain poor; recent reviews have estimated the 5-year survival for immunocompetent individuals at approximately 30% [ 1 , 4 ]. Congenital immunodeficiencies and other immunocompromised states—associated with, for example, human immunodeficiency virus (HIV) infection, immunomodulatory drug therapy and chemotherapy—increase the risk of PCNSL and confer even lower cancer survival rates [ 5 , 6 , 7 , 8 ].…”

Contribution Of Imaging-Genetics To Overall Survival Prediction Compared To Clinical Status For Pcnsl Patients

“…On the one hand, a Genomewide association study (GWAS) susceptibility study showed that some SNPs are associated with the onset of PCNSL [2]. On the other hand, retrospective survival analysis studies showed that different treatments and clinical characteristics had significant effects on survival [3]. Accurate survival analysis can be very helpful to personalize treatments.…”