Whether surgical resection or biopsy makes difference in single lesion primary central nervous system lymphoma: a single center retrospective cohort study

Abstract

Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive disease. The role of surgical resection in PCNSL has always been the center of debate. Here we investigated the clinical and follow-up data of single lesion PCNSL operated in our center, focusing on the comparison between surgical resection and biopsy. Methods All consecutive cases of single lesion PCNSL between October 2004 and December 2019 were retrospectively collected from the database of the Second Affiliated Hospital of Zhejiang University, School of Medicine. Patients were divided into resection group and biopsy group. Clinical information including age, gender, Karnofsky performance status, imaging features and postoperative treatment was collected from the medical records. All the patients were followed for survival analysis. Results A total of 105 patients with PCNSL were finally involved in our analysis. Neither PFS nor OS were significantly different between the resection group and biopsy group. The univariate analysis revealed that age < 60 and therapeutic treatment were significant predictors of longer PFS and OS. In the multivariate analysis, age (HR = 3.09, 95% CI 1.31–7.28, p = 0.01) and therapeutic treatment (HR = 0.25, 95% CI 0.07– 0.83, p = 0.02) were independent prognostic markers with OS. Multivariable Cox regression analyses also revealed that only age (HR = 2.29 (95% CI, 1.11–4.71, p = 0.03) was independent prognostic marker for PFS. Conclusions In single lesion PCNSL, there was no significant difference between the resection group and biopsy group for both PFS and OS. Younger age and postoperative treatment have been proved to be indicators of better prognosis.

Diagnostics and treatment delay in primary central nervous system lymphoma: What the neurosurgeon should know

“…Diagnostic delay of PCNSL is correlated with treatment delay, which is associated with earlier relapse and reduced survival in PCNSL [ 12 , 58 ]. Treatment selection is influenced by prognostic markers, such as age, clinical performance, and HIV-status.…”

“…Clinicians involved should strive to minimize delay in the diagnostic process of PCNSL to prevent progressive neurological symptomatology. Old age, clinical performance and treatment delay are correlated with a reduced survival in patients with PCNSL, who already have a limited prognosis [ 2 , 12 ].…”

“…Following neurosurgical intervention, patients are referred to the hematologist or neuro-oncologist for induction treatment with chemotherapy. It is important to start treatment for PCNSL as quickly as possible, since delay of induction treatment is associated with reduced PFS in PCNSL patients [ 12 , 58 ]. Currently, there is no uniform treatment for PCNSL and there are very few controlled studies available [ 53 ].…”

“…A study that compared the diagnostic delay in patients with PCNSL and patients with glioblastoma found a median delay of 19 days and 9.5 days respectively, suggesting that patients with PCNSL are more at risk of a delayed neurosurgical intervention. The delay was not in the period from clinical onset of symptoms to imaging, but seemed to occur between neuroimaging and morphological diagnosis [ 12 ]. Literature suggests that early biopsy for PCNSL is safe, valid, and may minimize diagnostic delay [ 46 ].…”

“…It generally takes two more weeks after biopsy until histopathological diagnosis of PCNSL and induction of treatment [ 48 ]. This results in a cumulative delay of more than 30 days, which is strongly correlated with a reduced survival compared to induction of treatment within one month [ 12 ].…”