背景:原发性中枢神经系统淋巴瘤(PCNSL)是一种罕见的结外淋巴瘤,具有独特的生物学行为。不断发展的PCNSL治疗方法极大地改善了患有该疾病的患者的预后,并激发了诊断为PCNSL的患者对第二恶性肿瘤(SM)的兴趣。
方法:梅奥诊所129例PCNSL的记录,在1988年1月1日至2012年11月26日之间诊断,我们进行了回顾。临床特征数据,实验室参数,治疗,结果,和SM被收集。平均随访时间为44.8个月(范围,0.5-240个月;中位数,28.0个月)。
结果:总之,发现28例,30例(23.26%)SMs。20例(15.50%)患者先前或同步患有SM。10名(7.76%)患者在PCNSL后发展为随后的原发癌。先前或同步SM的最常见部位是前列腺(4/20),皮肤(4/20),和胃肠道(3/20)。随后的SM的最常见部位是皮肤(4/10)。在先前的SM和随后的SM中都确定了2例。
结论:PCNSL患者的第二恶性肿瘤并不少见,发生在我们队列的近四分之一中。经常见到非黑色素瘤皮肤癌。因此,在PCNSL患者的长期随访中,还应考虑筛查SMs。此外,随后癌症的高发病率,同步癌症,常见的非黑色素瘤皮肤癌可能都表明PCNSL患者处于免疫抑制状态。
BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare extranodal lymphoma with distinctive biological behaviors. The evolving treatment of PCNSL has greatly improved the outcome for patients with this disease and has stimulated interest in second malignancies (SMs) in patients diagnosed with PCNSL.
METHODS: The records of 129 cases of PCNSL at Mayo Clinic, diagnosed between January 1, 1988, and November 26, 2012, were reviewed. Data on clinical characteristics, laboratory parameters, treatments, outcomes, and SMs were collected. The mean follow-up time was 44.8 months (range, 0.5-240 months; median, 28.0 months).
RESULTS: Altogether, 28 cases with 30 (23.26%) SMs were identified. Twenty (15.50%) patients had prior or synchronous SM. Ten (7.76%) patients developed a subsequent primary cancer after PCNSL. The most common sites of prior or synchronous SMs were prostate (4/20), skin (4/20), and gastrointestinal (3/20). The most common site of the subsequent SM was skin (4/10). Two cases were identified with both prior SM and subsequent SM.
CONCLUSIONS: Second malignancies in cases with PCNSL were not uncommon and occurred in nearly a quarter of our cohort. Nonmelanoma skin cancers were frequently seen. Therefore, screening for SMs should also be considered in long-term follow-up of patients with PCNSL. In addition, the high incidence of subsequent cancer, synchronous cancer, and frequently seen nonmelanoma skin cancers may all indicate an immunosuppressed state in patients with PCNSL.