Assessment of Clinical Manifestations, Prognostic Elements, Epidemiological Features and Management Outcomes in Primary Central Nervous System Lymphoma

Assessment of Clinical Manifestations,

Prognostic Elements, Epidemiological

Features and Management Outcomes

in Primary Central Nervous System

Lymphoma: A Large Population-

Based Analysis from 1967 – 1999

Kingsley O.D.E.C, Kingsley O. K, Smith S M and Burke E.W

London Medical Academy Research Consortium, London, England, United Kingdom

Abstract

Background:

Primary nervous system lymphoma impacts the brain and spinal cord, causing a wide range of neurological symptoms such as personality changes, memory issues, speech difficulties, weakness, and seizures. Its impact is rapid because the central nervous system controls essential functions like movement and thinking, so even small tumors can cause drastic changes. Outcomes vary, but early diagnosis is critical, as the cancer can be aggressive and have a poor prognosis if left untreated. 

Aim

The aim of this study is assess the clinical manifestations, epidemiological features, prognostic factors, and effects of treatment in patients with primary central nervous system lymphoma (PCNSL) with a strategy of improving diagnosis, treatment and outcomes for patients.

Method

This is a work in progress that started from 1955 as apart of a larger project on haematological diseases. It uses population-based research method, and epidemiological approaches to examine the clinical manifestations, epidemiological features, prognostic factors, and effects of treatment in patients with primary central nervous system lymphoma (PCNSL) with a strategy of improving diagnosis, treatment and outcomes for patients. This present study looked at patients diagnosed with PCNSL between 1967 and 1999 who were identified from the 19 AHCP Sponsored International Cancer Registries.

Results

The mean age was 65.2 ± 15.7 years, with a male to female ratio of 1.1:1.0. DLBCL (85.4%) was the most common histological subtype found. The 1^st, 3^rd, and 5^th year overall survival (OS) rates were 50.2%, 36.3%, and 29.2%, respectively, and the corresponding disease-specific survival (DSS) rates were 54.2%, 41.3%, and 33.4%, respectively. Race, sex, age, marital status, surgical resection, and chemotherapy were independent prognostic factors for OS and DSS, but radiotherapy was only for OS, as shown by multivariate statistical analysis with Cox regression. Significant statistical difference was found in OS with age, P < 0.0002; sex, P = 0.0078; race, P = 0.0013; and marital status, P < 0.0002.

Conclusion

The findings of this study showed that better OS and DSS were favourably associated with surgical resection and/or chemotherapy, but in the long term, radiotherapy was not beneficial for OS DSS.

Keywords: Primary central nervous system lymphoma, PCNSL, prognostic elements, diagnosis, treatment, diffuse large B-cell lymphoma, DLBCL.

Paper Published in the Royal College of General Practitioners, North and West London Faculty Magazine, Volume 2, Number 3, 2000. This publication is available at the British Library, Legal Deposit Office.