title: Prognostic scoring system for primary CNS lymphomas: the International Extranodal Lymphoma Study Group experience.
abstract: 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.
authors.affiliation: Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy. andres.ferreri@hsr.it
authors.forename: Andrés J M
authors.initials: AJ
authors.lastname: Ferreri
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.forename: Michele
authors.initials: M
authors.lastname: Reni
authors.forename: Felice
authors.initials: F
authors.lastname: Pasini
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.forename: Achille
authors.initials: A
authors.lastname: Ambrosetti
authors.forename: Antonello
authors.initials: A
authors.lastname: Calderoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Vavassori
authors.forename: Annarita
authors.initials: A
authors.lastname: Conconi
authors.forename: Liliana
authors.initials: L
authors.lastname: Devizzi
authors.forename: Françoise
authors.initials: F
authors.lastname: Berger
authors.forename: Maurilio
authors.initials: M
authors.lastname: Ponzoni
authors.forename: Bettina
authors.initials: B
authors.lastname: Borisch
authors.forename: Marianne
authors.initials: M
authors.lastname: Tinguely
authors.forename: Michele
authors.initials: M
authors.lastname: Cerati
authors.forename: Mario
authors.initials: M
authors.lastname: Milani
authors.forename: Enrico
authors.initials: E
authors.lastname: Orvieto
authors.forename: Juvenal
authors.initials: J
authors.lastname: Sanchez
authors.forename: Christine
authors.initials: C
authors.lastname: Chevreau
authors.forename: Stefania
authors.initials: S
authors.lastname: Dell'Oro
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
authors.forename: Franco
authors.initials: F
authors.lastname: Cavalli
mesh_terms: 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
chemical_list: D007770:L-Lactate Dehydrogenase