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- Title
Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study.
- Authors
Velasco, R.; Mercadal, S.; Vidal, N.; Alañá, M.; Barceló, M. I.; Ibáñez-Juliá, M. J.; Bobillo, S.; Caldú Agud, R.; García Molina, E.; Martínez, P.; Cacabelos, P.; Muntañola, A.; García-Catalán, G.; Sancho, J. M.; Camro, I.; Lado, T.; Erro, M. E.; Gómez-Vicente, L.; Salar, A.; Caballero, A. C.
- Abstract
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.
- Subjects
SPAIN; CENTRAL nervous system; OLDER patients; CASTRATION-resistant prostate cancer; LYMPHOMAS; PSYCHIATRIC diagnosis
- Publication
Journal of Neuro-Oncology, 2020, Vol 148, Issue 3, p545
- ISSN
0167-594X
- Publication type
Article
- DOI
10.1007/s11060-020-03547-z