Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience.
OBJECTIVE
To identify survival predictors and to design a prognostic score useful for distinguishing risk groups in immunocompetent patients with primary CNS lymphomas (PCNSL).


METHODS
The prognostic role of patient-, lymphoma-, and treatment-related variables was analyzed in a multicenter series of 378 PCNSL patients treated at 23 cancer centers from five different countries.


RESULTS
Age more than 60 years, performance status (PS) more than 1, elevated lactate dehydrogenase (LDH) serum level, high CSF protein concentration, and involvement of deep regions of the brain (periventricular regions, basal ganglia, brainstem, and/or cerebellum) were significantly and independently associated with a worse survival. These five variables were used to design a prognostic score. Each variable was assigned a value of either 0, if favorable, or 1, if unfavorable. The values were then added together to arrive at a final score, which was tested in 105 assessable patients for which complete data of all five variables were available. The 2-year overall survival (OS) +/- SD was 80% +/- 8%, 48% +/- 7%, and 15% +/- 7% (P =.00001) for patients with zero to one, two to three, and four to five unfavorable features, respectively. The prognostic role of this score was confirmed by limiting analysis to assessable patients treated with high-dose methotrexate-based chemotherapy (2-year OS +/- SD: 85% +/- 8%, 57% +/- 8%, and 24% +/- 11%; P =.0004).


CONCLUSIONS
Age, PS, LDH serum level, CSF protein concentration, and involvement of deep structures of the brain were independent predictors of survival. A prognostic score including these five parameters seems advisable in distinguishing different risk groups in PCNSL patients. The proposed score and its relevance in therapeutic decision deserve to be validated in further studies.
Ferreri
Andrés J M
AJ
Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy. andres.ferreri@hsr.it
Blay
Jean-Yves
JY
Reni
Michele
M
Pasini
Felice
F
Spina
Michele
M
Ambrosetti
Achille
A
Calderoni
Antonello
A
Rossi
Andrea
A
Vavassori
Vittorio
V
Conconi
Annarita
A
Devizzi
Liliana
L
Berger
Françoise
F
Ponzoni
Maurilio
M
Borisch
Bettina
B
Tinguely
Marianne
M
Cerati
Michele
M
Milani
Mario
M
Orvieto
Enrico
E
Sanchez
Juvenal
J
Chevreau
Christine
C
Dell'Oro
Stefania
S
Zucca
Emanuele
E
Cavalli
Franco
F
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D002555:Cerebrospinal Fluid / Q000378:metabolism; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000378:metabolism; D008223:Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome
D007770:L-Lactate Dehydrogenase