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The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

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Abstract

Surgical resection is not the standard of care for primary central nervous system lymphoma (PCNSL), as historical studies have demonstrated unfavorable complication rates and limited benefits. Some recent studies suggest that resection may provide a therapeutic benefit, yet the safety of these procedures has not been systematically investigated in the setting of modern neurosurgery. We examined the safety of surgical resection for PCNSL. We retrospectively analyzed all patients with PCNSL treated at Columbia University Medical Center between 2000 and 2015 to assess complications rates following biopsy or resection using the Glioma Outcomes Project system. We identified predictors of complications and selection for resection. Well-validated scales were used to quantify patients’ baseline clinical characteristics, including functional status, comorbid disease burden, and cardiac risk. The overall complication rate was 17.2% after resection, and 28.2% after biopsy. Cardiac risk (p = 0.047, OR 1.72 [1.01, 2.95]), and comorbid diagnoses (p = 0.004, OR 3.05 [1.42, 6.57]) predicted complications on multivariable regression. Patients who underwent resection had better KPS scores (median 70 v. 80, p = 0.0068, ∆ 10 [0.0, 10.00]), and were less likely to have multiple (46.5% v. 27.6%, p = 0.030, OR 1.42 [1.05, 1.92]) or deep lesions (70.4% v. 39.7%, p = 0.001, OR 1.83 [1.26, 2.65]). Age (p = 0.048, OR 0.75 per 10-year increase [0.56, 1.00]) and deep lesions (p = 0.003, OR 0.29 [0.13, 0.65]) influenced selection for resection on multivariable regression. Surgical resection of PCNSL is safe for select patients, with complication rates comparable to rates for other intracranial neoplasms. Whether there is a clinical benefit to resection cannot be concluded.

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Funding

NIH office of the Director, Award Number 1DP5OD021356-01, and Diversity Recruitment Award by the Office of Senior Associate Provost for Faculty Diversity and Inclusion, Columbia University.

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    Authors and Affiliations

    1. Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA

      Michael Brendan Cloney, Adam M. Sonabend, Jonathan Yun, Suprit Singh, Jeffrey N. Bruce, Michael Sisti, Sameer Sheth, E. Sander Connolly & Guy McKhann

    2. Department of Epidemiology, The Mailman School of Public Health, Columbia University, New York, NY, USA

      Jingyan Yang

    3. Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA

      Fabio Iwamoto

    4. Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA

      Govind Bhagat, Peter Canoll & George Zanazzi

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    1. Michael Brendan Cloney
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    Correspondence to Adam M. Sonabend.

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    Michael Brendan Cloney and Adam Sonabend contributed equally to this manuscript, and are co-first authors.

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    Cloney, M.B., Sonabend, A.M., Yun, J. et al. The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis. J Neurooncol 132, 189–197 (2017). https://doi.org/10.1007/s11060-016-2358-8

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