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Abstract：
BACKGROUND: Central nervous system lymphoma (CNSL) is rare form of brain tumour. It manifests either as primary CNS lymphoma (pCNSL) originating within the central nervous system or as secondary CNS lymphoma (sCNSL), arising as cerebral metastases of systemic lymphoma. For a significant period, surgical resection was considered obsolete due to the favourable response to chemotherapy and the associated risk of postoperative deficits. The objective of the present study was to demonstrate the benefits of resection in CNSL patients, including extended survival and improved postoperative function.
METHODS: A retrospective study involving patients diagnosed with either PCNSL or SCNSL that were surgically approached at our neurosurgical department between 2010 and 2022 was conducted. Patients were categorised into three subgroups based on their neurosurgical approach: (1) stereotactical biopsy, (2) open biopsy, (3) resection. We then performed statistical analyses to assess overall survival (OS) and progression-free survival (PFS). Additionally, we examined various secondary factors such as functional outcome via Karnofsky Performance Index (KPS) and prognosis scoring.
RESULTS: 157 patients diagnosed with PCNSL or SCNSL were enclosed in the study. Of these, 101 underwent stereotactic biopsy, 21 had open biopsy, and 35 underwent resection. Mean age of the cohort was 64.94 years, with majority of patients being female (54.1%). The resection group showed longest OS at 44 months (open biopsy = 13 months, stereotactic biopsy = 9 months). Calculated median follow-up was 34.5 months. In the Cox regression model, postoperative KPS 70% (p < 0.001) and resection vs. stereotactic biopsy (p = 0.040) were identified as protective factors, whereas older age at diagnosis was identified as a risk factor (p < 0.001). In the one-way analysis of variance, differences in postoperative KPS were found among all groups (p = 0.021), while there was no difference in preoperative KPS among the groups.
CONCLUSIONS: Our data show a favourable outcome when resection is compared to either stereotactic or open biopsy. Additionally, the marginally improved postoperative functional status observed in patients who underwent resection, as opposed to in those who underwent biopsy, provides further evidence in favour of the advantages of surgical resection for enhancing neurological deficits.
METHODS: A retrospective study involving patients diagnosed with either PCNSL or SCNSL that were surgically approached at our neurosurgical department between 2010 and 2022 was conducted. Patients were categorised into three subgroups based on their neurosurgical approach: (1) stereotactical biopsy, (2) open biopsy, (3) resection. We then performed statistical analyses to assess overall survival (OS) and progression-free survival (PFS). Additionally, we examined various secondary factors such as functional outcome via Karnofsky Performance Index (KPS) and prognosis scoring.
RESULTS: 157 patients diagnosed with PCNSL or SCNSL were enclosed in the study. Of these, 101 underwent stereotactic biopsy, 21 had open biopsy, and 35 underwent resection. Mean age of the cohort was 64.94 years, with majority of patients being female (54.1%). The resection group showed longest OS at 44 months (open biopsy = 13 months, stereotactic biopsy = 9 months). Calculated median follow-up was 34.5 months. In the Cox regression model, postoperative KPS 70% (p < 0.001) and resection vs. stereotactic biopsy (p = 0.040) were identified as protective factors, whereas older age at diagnosis was identified as a risk factor (p < 0.001). In the one-way analysis of variance, differences in postoperative KPS were found among all groups (p = 0.021), while there was no difference in preoperative KPS among the groups.
CONCLUSIONS: Our data show a favourable outcome when resection is compared to either stereotactic or open biopsy. Additionally, the marginally improved postoperative functional status observed in patients who underwent resection, as opposed to in those who underwent biopsy, provides further evidence in favour of the advantages of surgical resection for enhancing neurological deficits.
摘要：
背景：中枢神经系统淋巴瘤（CNSL）是一种罕见的脑肿瘤。它表现为起源于中枢神经系统的原发性CNS淋巴瘤（pCNSL）或继发性CNS淋巴瘤（sCNSL）。作为全身性淋巴瘤的脑转移。在一个重要的时期，手术切除被认为是过时的,因为对化疗的反应良好,并且存在相关的术后缺损风险.本研究的目的是证明切除CNSL患者的益处，包括延长生存期和改善术后功能。
方法：进行了一项回顾性研究，涉及2010年至2022年在我们神经外科手术治疗的PCNSL或SCNSL患者。根据神经外科手术方法将患者分为三个亚组：（1）立体定向活检，（2）开放活检，(3)切除。然后，我们进行了统计分析，以评估总生存期（OS）和无进展生存期（PFS）。此外,我们通过Karnofsky绩效指数(KPS)和预后评分检查了各种次要因素,如功能结局.
结果：157例诊断为PCNSL或SCNSL的患者纳入研究。其中,101接受了立体定向活检，21有开放活检，35人接受了切除术。该队列的平均年龄为64.94岁，大多数患者为女性（54.1%）。切除组在44个月时显示最长的OS（开放活检=13个月，立体定向活检=9个月）。计算的中位随访时间为34.5个月。在Cox回归模型中，术后KPS70%(p<0.001)和切除与立体定向活检(p=0.040)被确定为保护因素，而诊断时年龄较大被确定为危险因素(p<0.001).在单向方差分析中，术后KPS在所有组间均有差异（p=0.021），而术前KPS组间无差异。
结论：我们的数据显示，与立体定向或开放活检相比，切除结果良好。此外,在接受切除术的患者中观察到的术后功能状态略有改善，与那些接受活检的人相反，提供了进一步的证据，支持手术切除增强神经功能缺损的优势。
方法：进行了一项回顾性研究，涉及2010年至2022年在我们神经外科手术治疗的PCNSL或SCNSL患者。根据神经外科手术方法将患者分为三个亚组：（1）立体定向活检，（2）开放活检，(3)切除。然后，我们进行了统计分析，以评估总生存期（OS）和无进展生存期（PFS）。此外,我们通过Karnofsky绩效指数(KPS)和预后评分检查了各种次要因素,如功能结局.
结果：157例诊断为PCNSL或SCNSL的患者纳入研究。其中,101接受了立体定向活检，21有开放活检，35人接受了切除术。该队列的平均年龄为64.94岁，大多数患者为女性（54.1%）。切除组在44个月时显示最长的OS（开放活检=13个月，立体定向活检=9个月）。计算的中位随访时间为34.5个月。在Cox回归模型中，术后KPS70%(p<0.001)和切除与立体定向活检(p=0.040)被确定为保护因素，而诊断时年龄较大被确定为危险因素(p<0.001).在单向方差分析中，术后KPS在所有组间均有差异（p=0.021），而术前KPS组间无差异。
结论：我们的数据显示，与立体定向或开放活检相比，切除结果良好。此外,在接受切除术的患者中观察到的术后功能状态略有改善，与那些接受活检的人相反，提供了进一步的证据，支持手术切除增强神经功能缺损的优势。
