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1、Prognostic Scoring System for Primary CNS Lymphomas: The International Extranodal Lymphoma Study Group ExperienceBy Andre s J.M. Ferreri, Jean-Yves Blay, Michele Reni, Felice Pasini, Michele Spina, Achille Ambrosetti, Antonello Calderoni, Andrea Rossi, Vittorio Vavassori, Annarita Conconi, Liliana D
2、evizzi, Franc oise Berger, Maurilio Ponzoni, Bettina Borisch, Marianne Tinguely, Michele Cerati, Mario Milani, Enrico Orvieto, Juvenal Sanchez, Christine Chevreau, Stefania DellOro, Emanuele Zucca, and Franco CavalliPurpose:To identify survival predictors and to design a prognostic score useful for
3、distinguishing risk groups in immu- nocompetent patients with primary CNS lymphomas (PCNSL). Patients and Methods:The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patients treated at 23cancer centers from five different cou
4、ntries. Results:Age more than 60 years, performance status (PS) more than 1, elevated lactate dehydrogenase (LDH) serum level, high CSF protein concentration, and involve- ment of deep regions of the brain (periventricular regions,basal ganglia, brainstem, and/or cerebellum) were signifi- cantly and
5、 independently associated with a worse survival.These five variables were used to design a prognostic score. Each variable was assigned a value of either 0, if favorable, or 1, if unfavorable. The values were then added together toarrive at a final score, which was tested in 105 assessablepatients f
6、or which complete data of all five variables were available. The 2-year overall survival (OS) ? SD was 80% ? 8%, 48% ? 7%, and 15% ? 7% (P ? .00001) for patients withzero to one, two to three, and four to five unfavorable fea- tures, respectively. The prognostic role of this score was con-firmed by
7、limiting analysis to assessable patients treated with high-dose methotrexate-based chemotherapy (2-year OS ? SD: 85% ? 8%, 57% ? 8%, and 24% ? 11%; P ? .0004). Conclusion:Age, PS, LDH serum level, CSF protein con- centration, and involvement of deep structures of the brain were independent predictor
8、s of survival. A prognostic scoreincluding these five parameters seems advisable in distin- guishing different risk groups in PCNSL patients. The pro- posed score and its relevance in therapeutic decision de- serve to be validated in further studies. JClinOncol21:266-272.2003byAmerican Society of Cl
9、inical Oncology.IN SERIES investigating the management of primary CNS lymphomas (PCNSL), the differences in outcome observed among various treatment options have been attributed to an inhomogeneous distribution of prognostic indicators rather thanthe real efficacy of therapeutic strategies.1Indeed,
10、apart from age and performance status (PS), which are universally accepted prognostic factors,1,2no other parameters influencing outcomehave been consistently identified. Efforts to identify predictors of response and survival in PCNSL have produced isolated observations in small series,which have n
11、ot been confirmed in successive studies. The characterization of predictors of response and survival using large series may allow us to identify different patient risk groups, facilitate the comparative analysis of prospective trials, anddefi ne stratification criteria for future trials. In this stu
12、dy, predictors of response and survival were analyzed in an interna- tional multicenter retrospective series of 378 immunocompetent patients with PCNSL. A prognostic score resulting from the combined analysis of the independent variables is proposed in light of its potential clinical relevance.PATIE
13、NTS AND METHODSStudy GroupA questionnaire requesting information about patient characteristics, clinical presentation, diagnosis, staging, planned and actually performed treatment, objective response, site and date of relapse, second-line treatment, neurotoxicity, and survival was sent to 48 centers
14、 referring to the Interna- tional Extranodal Lymphoma Study Group. Report forms were submitted to at least one clinician (hematologist or oncologist) and one pathologist per center. Only patient cases diagnosed and treated at the participating institu-tions that fulfilled the following criteria were
15、 selected: (1) histologic or cytologic diagnosis of lymphoma; (2) disease localized exclusively in the brain, cranial nerves, meninges, or eyes; and (3) no evidence of humanimmunodeficiency virus-1 infection (negative serologic tests and absence ofFrom the Departments of Radiochemotherapy and Pathol
16、ogy, San Raffaele HScientific Institute, and Divisione di Oncologia Medica, Istituto Nazionale dei Tumori, Milan; Divisione di Radioterapia, Ospedale di Circolo e Fondazione Macchi, and Anatomia e Istologia Patologica, Ospedale di Circolo Fondazione Macchi, Universita dellInsubria, Varese; Divisione Clinicizzata di Oncologia Medica, Ospedale Civile Maggiore, and Cattedra di Ematologia, Universita di Verona, Ospedale Policlinico di Borgo Roma, Verona; Division of Medical Oncology “A,” Ce
