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Craniotomy versus biopsy for primary CNS lymphoma: An institutional series and nationwide NCDB‐PUF and SEER database study

Year: 2017
Type: conference-abstract
Abstract: Introduction: Historically, resection for Primary Central Nervous System Lymphoma (PCNSL) was considered high-risk and not beneficial. We investigated survival following craniotomy in 3 modern and complementary datasets. Methods: The National Cancer Database-Participant User File (NCDB-PUF) (n = 9,435), the Surveillance, Epidemiology, and End Results Program (SEER) (n = 5,615), and an institutional series (IS) (n = 132) were used. We identified prognostic scales and investigated their effects on survival. Results: In NCDB, craniotomy was associated with increased survival over biopsy (23.16 vs 11.6 months, HR 1.26, p < 0.001), with a similar trend in IS (HR 1.48, p = 0.15). In SEER, gross total resection (GTR) was associated with increased survival over biopsy (29 vs 10 months, HR 1.22, p < 0.001). (GTR vs STR vs biopsy was associated with a 22% interval increase in risk of mortality (HR 1.22, p < 0.001). We explored factors that might influence the relationship between craniotomy and survival, and found that within Recursive Partitioning Analysis class 1 (RPA1), craniotomy was associated with increased survival over biopsy in NCDB (106.78 v. 32.85 months, HR 1.56, p < 0.001). The survival benefit associated with craniotomy was smaller for RPA > 1 (17.71 vs 10.28 months, HR 1.23, P < 0.001). We created a surgical risk category (RC) considering lesion access, which was predictive of survival (HR 2.27, p = 0.003). Craniotomy was only associated with increased survival over biopsy for patients with low-RC (133.37 vs 37.21 months, HR 2.16, p = 0.040). Conclusion: Craniotomy is associated with increased survival over biopsy for PCNSL. Cytoreductive surgery might play a therapeutic role for these tumors, but to attribute causality and address biases, prospective studies are necessary. The design of such studies should stratify patients by prognostic factors. Keywords: primary CNS lymphoma (PCNSL)
DOI: 10.1002/hon.2439_108
Language: English
Field: Medicine
Open Access status: bronze
OpenAlex ID: W2623678086
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