Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study
Por:
Velasco, R, Mercadal, S, Vidal, N, Alana, M, Barcelo, MI, Ibanez-Julia, MJ, Bobillo, S, Agud, RC, Molina, EG, Martinez, P, Cacabelos, P, Muntanola, A, Garcia-Catalan, G, Sancho, JM, Camro, I, Lado, T, Erro, ME, Gomez-Vicente, L, Salar, A, Caballero, AC, Sole-Rodriguez, M, Perez-Larraya, JG, Huertas, N, Estela, J, Baron, M, Barbero-Bordallo, N, Encuentra, M, Dlouhy, I, Bruna, J, Graus, F
Publicada:
1 jul 2020
Ahead of Print:
1 jun 2020
Resumen:
Introduction To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. Methods Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. Results Median age was 64 years (range: 19-84; 33% >= 70 years), 54% were men, and 59% had a performance status (PS) >= 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS >= 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients >= 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age >= 65 years, PS >= 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. Conclusions Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients >= 70 years.
Filiaciones:
Velasco, R:
Hosp Univ Bellvitge ICO Duran i Reynals, Neurooncol Unit, IDIBELL, Barcelona, Spain
Univ Autonoma Barcelona, Inst Neurosci, Dept Cell Biol Physiol & Immunol, Bellaterra, Spain
Ctr Invest Biomed Red Enfermedades Neurodegenerat, Bellaterra, Spain
Hosp Univ Bellvitge, Neurooncol Unit, Dept Neurol, C Feixa Llarga S-N, Barcelona 08907, Spain
ICO Hosp, C Feixa Llarga S-N, Barcelona 08907, Spain
Mercadal, S:
Univ Barcelona, Dept Hematol, Catalan Inst Oncol, Hosp Duran i Reynals,IDIBELL, Barcelona, Spain
Vidal, N:
Hosp Univ Bellvitge ICO Duran i Reynals, Neurooncol Unit, IDIBELL, Barcelona, Spain
Hosp Univ Bellvitge, Dept Pathol, ICO Duran i Reynals, IDIBELL,Unit Neurooncol, Barcelona, Spain
Alana, M:
Complejo Asistencial Univ, Dept Neurol, Salamanca, Spain
Barcelo, MI:
Hosp Univ Son Espases, Dept Neurol, Palma De Mallorca, Spain
Ibanez-Julia, MJ:
Hosp Univ & Politecn La Fe, Dept Neurol, Valencia, Spain
Bobillo, S:
Univ Hosp Vall dHebron, Vall dHebron Inst Oncol VHIO, Dept Hematol, Barcelona, Spain
Agud, RC:
Hosp Univ Miguel Servet, Dept Neurol, Zaragoza, Spain
Molina, EG:
Virgen Arrixaca Univ Hosp, Dept Neurol, Murcia, Spain
Martinez, P:
Hosp Univ 12 Octubre, Dept Hematol, Madrid, Spain
Cacabelos, P:
Hosp Clin Univ Santiago de Compostela, Dept Neurol, Santiago De Compostela, La Coruna, Spain
Muntanola, A:
Hosp Univ Mutua Terrassa, Dept Hematol, Terrassa, Spain
Garcia-Catalan, G:
Hosp Univ Marques de Valdecilla, Dept Neurosurg, Santander, Spain
Sancho, JM:
ICO ITC Hosp Germans Trias & Pujol, Dept Hematol, Badalona, Spain
Camro, I:
Hosp Univ Cruces, Dept Neurol, Vizcaya, Spain
Lado, T:
Hosp Clin Univ Valladolid, Dept Hematol, Valladolid, Spain
Erro, ME:
Complejo Hosp Navarra, Navarra Inst Hlth Res IdiSNA, Neurol Dept, Pamplona, Spain
Gomez-Vicente, L:
Hosp Univ Quironsalud Madrid, Dept Neurol, Madrid, Spain
Salar, A:
Hosp del Mar, Dept Hematol, Barcelona, Spain
Caballero, AC:
Hosp Santa Creu & Sant Pau, Dept Hematol, Barcelona, Spain
Sole-Rodriguez, M:
Hosp Univ Virgen del Rocio, Dept Hematol, Seville, Spain
Perez-Larraya, JG:
Inst Invest Sanitaria Navarra, Clin Univ Navarra, Dept Neurol, IdiSNA, Pamplona, Spain
Huertas, N:
Hosp Univ Severo Ochoa, Dept Neurol, Madrid, Spain
Estela, J:
Hosp Parc Tauli, Dept Neurol, Sabadell, Spain
Baron, M:
Hosp Univ Fdn Alcorcon, Unit Neurol, Madrid, Spain
Barbero-Bordallo, N:
Hosp Univ Rey Juan Carlos, Dept Neurol, HURJC HUIE HCV, Madrid, Spain
Encuentra, M:
Univ Barcelona, Dept Hematol, Catalan Inst Oncol, Hosp Duran i Reynals,IDIBELL, Barcelona, Spain
Dlouhy, I:
Hosp Clin Barcelona, Dept Hematol & Neurol, Barcelona, Spain
Bruna, J:
Hosp Univ Bellvitge ICO Duran i Reynals, Neurooncol Unit, IDIBELL, Barcelona, Spain
Univ Autonoma Barcelona, Inst Neurosci, Dept Cell Biol Physiol & Immunol, Bellaterra, Spain
Ctr Invest Biomed Red Enfermedades Neurodegenerat, Bellaterra, Spain
Graus, F:
Hosp Clin Barcelona, Dept Hematol & Neurol, Barcelona, Spain
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