Real-World Impact of Surgical Excision on Overall Survival in Primary Central Nervous System Lymphoma

Abstract

Substantial controversy still exists regarding the use of surgical excision in the treatment of primary central nervous system lymphoma (PCNSL). This study was aimed to evaluate the survival benefit of surgical excision in PCNSL patients based on a US population. Using the Surveillance, Epidemiology, and End Results (SEER) Program database, a total of 3,543 PCNSL patients were identified from 2000 to 2014 for analysis. Surgical excision was accessed via Kaplan-Meier and multivariate Cox regression survival analyses. Coarsened exact matching (CEM) analysis was additionally employed to intensify our findings. Finally, we found that surgical excision was significantly associated with increased survival over no surgery/biopsy (P < 0.001), and its survival benefit was also independent of baseline prognostic factors. The survival benefit of surgery was also validated in clinically important subsets. CEM analysis further validated the survival advantage of surgery (P < 0.001). Moreover, a novel prediction model with excellent performance was established to estimate the potential benefit from surgical excision of the lesion with respect to the end point of overall survival. The current study supports the favorable impact of surgical excision on clinical outcome in patients with PCNSL. Although further randomized controlled trials are warranted, currently available evidence should be considered in the clinical management of this disease.

Is It Time to Remove Radiotherapy in the Management of Primary Central Nervous System Lymphoma? Population-based Study, Pool-Analysis and Retrospective Study of Recurrence Pattern.

“…To better understand the pattern and mechanism of relapse, we reviewed 27 relapsed patients who attained complete response (CR), partial response (PR) or stable disease (SD) during or after first-line treatment without WBRT for newly diagnosed PCNSL in our institution. We found more than half of the patients had distant recurrence and among those reached CR patients, 9/11(82%)had distant recurrence as well, which are comparable to those described with intravenous HD-MTX (12/16, 75%) 33 and those with intra-arterial HD-MTX in conjunction with blood-brain barrier disruption (BBBD) 50 (30/37, 80%).Recently, a number of studies [51][52][53][54][55] have shown that surgery may be beneficial for PCNSL patients. It is worth noting that 8 of the 11patients who achieved CR by receiving GTR, eventually relapsed with DR, which reminds us that there may be subclinical CNS lymphomas which contrast enhanced MRI cannot to detect.…”

Diagnosis, prognosis and treatment of primary central nervous system lymphoma in the elderly population (Review)

“…A new nomogram model (Fig. 4) was established, which may offer an individualized quantitative potential benefit from surgical excision to patients with PCNSL (136). The nomogram model was internally validated using the bootstrap validation method.…”

“…4C). This practical clinical tool may provide more distinct and direct data to assist clinical decision-making and optimization of therapeutic approaches in clinical care (136).…”

“…Maintenance therapy with lenalidomide alone was recommended to responding patients, and the median PFS and OS were 7.8 and 17.7 months, respectively (164). In addition, a previous study revealed that reduced-dose MTX-based treatment followed by low-dose lenalidomide maintenance was well-tolerated in patients aged ≥70 years, and associated with excellent PFS and OS (136). Pomalidomide is a novel immunomodulatory drug with anti-lymphoma activity.…”

“…(C) Time-dependent ROC curve analysis confirmed that the nomogram had the best performance. Images taken from the study by Deng et al(136). AUC, area under the curve; OS, overall survival; PCNSL, primary central nervous system lymphoma; ROC, receiver operating characteristic.…”