Nomograms Predict Survival Outcome of Primary Intramedullary Spinal Cord Lymphoma Patients

Abstract

BackgroundPrimary intramedullary spinal cord lymphoma (PISCL) is a rare cause of myelopathies. Considering its poor prognosis, it is essential to determine the appropriate treatment strategies and to develop nomograms to predict survival outcome for PISCL patients.Material/MethodsData were collected from the Surveillance, Epidemiology and End Results (SEER) database. We used 364 patients to investigate overall survival (OS) and 289 patients for cancer-specific survival (CSS). Kaplan-Meier method was to evaluate correlations of survival with different treatment strategies and clinicopathologic factors. Univariate and multivariable analyses were conducted to assess OS and CSS based on different variables. Risk factors were integrated to build nomograms.ResultsMost of the 414 PISCL patients diagnosed with positive histology had diffuse B cell lymphoma, were under 60 years old, were male, were of white race, had 1 primary tumor, were married, were low stage, and had previously undergone chemotherapy. We found that radiation therapy had no effect on patient OS and CSS, and patients receiving chemotherapy alone tended to have better OS and CSS in comparison with other groups. In addition, we showed that clinicopathologic factors, including histologic type, age, stage, and marital status, could serve as independent prognostic factors for PISCL patient OS and CSS. These factors were utilized to construct nomograms. The calibration curves demonstrated good agreement. The concordance indexes for OS and CSS were 0.672 (P=0.024) and 0.683 (P=0.029), respectively.ConclusionsPractical nomograms were established for patients’ OS and CSS. Besides, this study can guild clinician to make the right decision for appropriate treatment of PISCL patients.

Conditional survival of patients with primary bone lymphoma of the spine: how survival changes after initial diagnosis

“…While several articles have explored spinal intramedullary lymphomas ( 20 ), research specific to PBL of the spine remains substantially lacking. This is the first study to analyze the CS trend of spinal PBLs, and we observed that that the instantaneous survival rates of PBL of the spine progressively augmented over time.…”

Essentials for early diagnosis of primary intramedullary spinal cord lymphoma. How to suspect primary intramedullary spinal cord lymphoma early and proceed to invasive biopsy? A case report and literature review

“…[ 3 ] With regard to long-term efficacy, chemotherapy alone appears more beneficial than other treatment modalities, but detailed reports on that regimen remain lacking. [ 3 , 13 ] On the other hand, the dose of radiotherapy is related to effectiveness, with doses <40 Gy associated with a high risk of poor therapeutic response and recurrence. [ 2 ] In the present case, four cycles of chemotherapy with the R-MPV regimen and radiation therapy (40 Gy) were added, and the patient remained recurrence-free for at least ten months after treatment.…”

Primary intramedullary spinal cord lymphoma misdiagnosed as longitudinally extensive transverse myelitis: a case report and literature review

“…The unique advantage of surgery lay in the immediate symptom remission in the postoperative period. With regard to long-term effects, chemotherapy separately was more beneficial compared with other therapy methods [ 1 , 5 , 38 ]. The dose of radiotherapy was connected with the efficacy and the patients might be at great risk of poor response to treatment and recurrence when the radiation dose was less than 40 Gy [ 39 ].…”

“…The majority of patients have a later onset in 50, mainly involving the thoracic and cervical segment with poor long-term survival and high mortality. Despite some cases previously reported, the characteristics and progress of the disease still remains poorly understood along with delayed diagnosis and hence delayed in treatment [ 5 – 7 ]. Therefore it should take this disease into consideration when the patient has myelopathy with unknown etiology.…”