J Cancer 2019; 10(17):3958-3966. doi:10.7150/jca.32467 This issue

Research Paper

Risk Prediction for Early Mortality in Patients with Newly Diagnosed Primary CNS Lymphoma

Chia-Hsin Lin1,2, Ching-Fen Yang3, Huai-Che Yang4,5, Li-Yu Fay4, Chiu-Mei Yeh6,7, Ai-Seon Kuan8, Hao-Yuan Wang2,6, Jyh-Pyng Gau2,6, Liang-Tsai Hsiao2,6, Tzeon-Jye Chiou2,9, Po-Min Chen2,6, Yao-Chung Liu2,6, Po-Shen Ko2,6, Jin-Hwang Liu6,10,11, Chia-Jen Liu6,7✉

1. Department of Radiation Oncology, Linkou Chang Gung Memorial Hospital Medical Center, Taoyuan City, Taiwan
2. School of Medicine, National Yang-Ming University, Taipei, Taiwan
3. Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
4. Department of Neurosurgery, Taipei Veterans General Hospital
5. Institute of Brain Science, National Yang-Ming University
6. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
7. Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
8. Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
9. Division of Transfusion Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
10. Institute of Biopharmaceutical Sciences, National Yang-Ming University, Taipei, Taiwan
11. Chong Hin Loon Memorial Cancer and Biotherapy Research Center, National Yang-Ming University, Taipei, Taiwan

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Citation:
Lin CH, Yang CF, Yang HC, Fay LY, Yeh CM, Kuan AS, Wang HY, Gau JP, Hsiao LT, Chiou TJ, Chen PM, Liu YC, Ko PS, Liu JH, Liu CJ. Risk Prediction for Early Mortality in Patients with Newly Diagnosed Primary CNS Lymphoma. J Cancer 2019; 10(17):3958-3966. doi:10.7150/jca.32467. Available from https://www.jcancer.org/v10p3958.htm

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Abstract

Background: Overall survival of patients with primary CNS lymphoma (PCNSL) has improved since the introduction of immunochemotherapy. However, up to 10-15% of PCNSL patients still die shortly after diagnosis. In the present study, we aimed to investigate the risk factors of early mortality (death within 60 days after diagnosis) in patients with PCNSL.

Methods: We included newly diagnosed PCNSL patients in a tertiary medical center in Taiwan between January 1, 2002 and May 31, 2018. Clinical risk factors were collected and compared between PCNSL patients who had and did not have early mortality.

Results: A total of 133 consecutive patients with PCNSL were included in this study. Approximately 9.8% of the PCNSL patients had early mortality. In multivariate analysis, age ≥ 80 (adjusted hazard ratio [HR] 3.34, 95% confidence interval [CI] 1.01-11.04, p = 0.048) and involvement of the basal ganglia (adjusted HR 4.85, 95% CI 1.47-15.95, p = 0.009) were identified as independent risk factors of early mortality. Use of MTX-based chemotherapy served as an independent protective factor for early mortality (adjusted HR 0.19, 95% CI 0.05-0.67, p = 0.010). Infection and tumor-associated mass effect contributed most to early mortality.

Conclusion: Early mortality is not uncommon in patients with PCNSL. Identification of patients with higher risk may help clinicians with initiating appropriate surveillance and management.

Keywords: Early mortality, epidemiology, primary CNS lymphoma, prognostic factors