原发性中枢神经系统淋巴瘤临床及预后分析

目的:总结原发性中枢神经系统淋巴瘤(PCNSL)的临床特点、诊治方案及临床疗效.方法:回顾收活的21例PCNSL患者,均为病理确诊的B细胞来源非霍奇金淋巴瘤,其中5例接受单纯放疗,16例接受放化疗.对病理学检查、影像学表现、治疗及预后进行总结分析.结果:PCNSL以中老年人多见,发病急,病程短,病情进展快.临床表现复杂,颅内高压为主要表现之一.CT、MR增强扫描病灶多呈均匀明显强化,可单发或多发.21例患者中位生存时间22个月,1、3和5年生存率分别为76.2％、28.6％和4.76％.放化疗疗效优于单纯放疗,P=0.029.结论:PCNSL临床表现多样,影像学缺乏特异性,极易误诊,确诊需要依靠病理学检查,其最佳治疗方案是三维立体定向穿刺活检加放疗、化疗的联合治疗.PCNSL侵袭性强,生存期短,其预后主要与发病年龄、多灶性和体力状况有关.

Clinical and prognostic factors with primary central nervous system lymphoma

OBJECTIVE:To summary the clinical features,diagnosis and treatment of primary central nervous system lymphoma(PCNSL).METHODS:A total of 21 patients were confirmed non-Hodgkin’s lymphoma with patho-logy.The tumor were all B lymphocyte origin.Five patients received radiotherapy while 16 patients received chemotherapy combined with radiotherapy.In combination with literatures,the clinical characteristics,features of images,pathology and therapeutic efficacy of PCNSL were retrospectively analyzed.RESULTS:These patients who were of middle age or old had acute disease onset and rapid disease progression.Increased intracranial pressure was the main clinical manifestation.Enhanced CT or MR scanning showed the mass contrasted evenly and obviously in the patients who had single or multi-locus lesion.21 patients were alive with a median follow-up of 22 months.The 1-,3-,5-year survival rates were 76.2%,28.6% and 4.76% respectively.Statistical difference existed between the group received radiotherapy and the group received radiotherapy combined with chemotherapy(P=0.029).CONCLUSIONS:PCNSL has diversify clinical manifestations,but no specific imaging performance and it is easy misdiagnosed.The pathological examination may be the only reliable method to confirm PCNSL.The best therapy was the Three-dimensional stereotactic biopsy combined with radiotherapy and chemotherapy.PCNSL has strong invasive ability and poor prognosis.The prognosis is related with the age at diagnosis,multifocal lesion and performance status of the patients.