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

Chia-Hsin Lin; Ching-Fen Yang; Huai-Che Yang; Li-Yu Fay; Chiu-Mei Yeh; Ai-Seon Kuan; Hao-Yuan Wang; Jyh-Pyng Gau; Liang-Tsai Hsiao; Tzeon-Jye Chiou; Po-Min Chen; Yao-Chung Liu; Po-Shen Ko; Jin-Hwang Liu; Chia-Jen Liu

doi:10.7150/jca.32467

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

J Cancer. 2019 Jul 5;10(17):3958-3966. doi: 10.7150/jca.32467. eCollection 2019.

Authors

Chia-Hsin Lin^{1

2}, Ching-Fen Yang³, Huai-Che Yang^{4

5}, Li-Yu Fay⁴, Chiu-Mei Yeh^{6

7}, Ai-Seon Kuan⁸, Hao-Yuan Wang^{2

6}, Jyh-Pyng Gau^{2

6}, Liang-Tsai Hsiao^{2

6}, Tzeon-Jye Chiou^{2

9}, Po-Min Chen^{2

6}, Yao-Chung Liu^{2

6}, Po-Shen Ko^{2

6}, Jin-Hwang Liu^{6

10

11}, Chia-Jen Liu^{6

7}

Affiliations

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.

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.