title: The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis.
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.
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Michael Brendan
authors.initials: MB
authors.lastname: Cloney
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA. as3537@cumc.columbia.edu.
authors.forename: Adam M
authors.identifier: 0000-0001-5791-7547
authors.initials: AM
authors.lastname: Sonabend
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Yun
authors.affiliation: Department of Epidemiology, The Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Jingyan
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Fabio
authors.initials: F
authors.lastname: Iwamoto
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Suprit
authors.initials: S
authors.lastname: Singh
authors.affiliation: Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Govind
authors.initials: G
authors.lastname: Bhagat
authors.affiliation: Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Canoll
authors.affiliation: Department of Pathology and Cell Biology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
authors.forename: George
authors.initials: G
authors.lastname: Zanazzi
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Sisti
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Sameer
authors.initials: S
authors.lastname: Sheth
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, 710 W 168th Street, Room 426, New York, NY, 10032, USA.
authors.forename: Guy
authors.initials: G
authors.lastname: McKhann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000009:adverse effects; D001932:Brain Neoplasms / Q000601:surgery; D016543:Central Nervous System Neoplasms / Q000601:surgery*; D006801:Humans; D008223:Lymphoma / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012189:Retrospective Studies; D055815:Young Adult
keywords: CNS lymphoma; Central nervous system lymphoma; Complications; PCNSL; Resection