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Clinicopathological risk factors for a poor prognosis of primary central nervous system lymphoma in elderly patients in the Tohoku and Niigata area: a multicenter, retrospective, cohort study of the Tohoku Brain Tumor Study Group

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Abstract

Clinicopathological risk factors for a poor prognosis were investigated in elderly patients with malignant lymphoma of the central nervous system. A total of 82 pathologically confirmed, CD20-positive, diffuse large B-cell lymphoma patients aged 71 years or older who underwent therapeutic intervention in the Tohoku and Niigata area in Japan were retrospectively reviewed. A univariate analysis was performed by the log-rank test using the Kaplan–Meier method. A Cox proportional hazards model was used for multivariate analysis of risk factors. Of the 82 patients, 39 were male and 43 were female, and their median age at onset was 75 years. At the end of the study, there were 34 relapse-free patients (41.5%), 48 relapse cases (58.5%), median progression-free survival was 18 months, and median overall survival (OS) was 26 months; there were 41 deaths and 41 survivors. Multivariate analysis of median OS showed that Karnofsky Performance Status less than 60% 3 months after treatment (p = 0.022, hazard ratio (HR) = 2.591) was the clinical risk factor, and double expressor lymphoma (p = 0.004, HR = 3.163), expression of programmed death-ligand 1 in tumor infiltrating lymphocytes or tumor-associated macrophages (p < 0.001, HR = 5.455), and Epstein–Barr virus infection (p = 0.031, HR = 5.304) were the pathological risk factors.

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Acknowledgements

The authors would like to express their appreciation to all those who contributed to our study. Yuichi Sato MD, PhD (Department of Neurosurgery, Iwate Medical University), Professor Masazumi Fujii MD, PhD (Department of Neurosurgery, Fukushima Medical University), Yoshihiro Kameoka MD, PhD, (Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine), all the doctors at all the institutions and the members of the Tohoku Brain Tumor Study Group, and all the staff of the Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine.

Funding

This study did not receive any funding.

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Authors and Affiliations

  1. Department of Neurosurgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562, Japan

    Kenichiro Asano, Toshio Fumoto & Hiroki Ohkuma

  2. Department of Neurosurgery, Miyagi Cancer Center, Natori, Japan

    Yoji Yamashita

  3. Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan

    Takahiro Ono & Hiroaki Shimizu

  4. Department of Neurosurgery, Brain Research Institute, University of Niigata, Niigata, Japan

    Manabu Natsumeda & Yukihiko Fujii

  5. Department of Neurosurgery, Iwate Medical University, Morioka, Japan

    Takaaki Beppu & Kuniaki Ogasawara

  6. Department of Neurosurgery, Faculty of Medicine, Yamagata University, Yamagata, Japan

    Kenichiro Matsuda & Yukihiko Sonoda

  7. Department of Neurosurgery, Fukushima Medical University, Fukushima, Japan

    Masahiro Ichikawa & Kiyoshi Saito

  8. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan

    Masayuki Kanamori & Teiji Tominaga

  9. Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Japan

    Masashi Matsuzaka

  10. Department of Anatomic Pathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    Akira Kurose

  11. Department of Neurosurgery, Fukushima Rosai Hospital, Iwaki, Japan

    Kiyoshi Saito

  12. Department of Neurosurgery, National Hospital Organization, Hirosaki National Hospital, Hirosaki, Japan

    Hiroki Ohkuma

  13. Department of Molecular Cancer Science, Faculty of Medicine, Yamagata University, Yamagata, Japan

    Chifumi Kitanaka

  14. Department of Advanced Cancer Medicine, Yamagata University Graduate School of Medical Science, Yamagata, Japan

    Takamasa Kayama

Authors
  1. Kenichiro Asano
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Contributions

KA and HO contributed to the concept and design of the study. KA and MM contributed to the acquisition and analysis of the data. AK and KA contributed to central pathological diagnosis. All authors contributed to drafting the text and preparing the figure. KA, YY, TO, MN, TB, KM, MI, MK, and TF contributed to acquisition of the data in individual institutions. KS, YS, KO, YF, HS, HO, and TT contributed to supervision in individual institutions. YS, CK, TK, and TT contributed to supervision and advising on the whole project.

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Correspondence to Kenichiro Asano.

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10014_2022_427_MOESM1_ESM.tif

Supplementary file1 Supplementary Fig. 1 Kaplan–Meier curves of double hit score (DHS) 0, 1, and 2. OS comparing DHS 0 (light gray line), DHS 1 (gray line), and DHS 2 (black line). There are significant differences between DHS 0 vs DHS 2 and DHS 1 vs DHS 2 (p=0.035 and p=0.017, respectively) (TIF 41239 KB)

Supplementary file2 (DOCX 32 KB)

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Asano, K., Yamashita, Y., Ono, T. et al. Clinicopathological risk factors for a poor prognosis of primary central nervous system lymphoma in elderly patients in the Tohoku and Niigata area: a multicenter, retrospective, cohort study of the Tohoku Brain Tumor Study Group. Brain Tumor Pathol 39, 139–150 (2022). https://doi.org/10.1007/s10014-022-00427-4

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