Craniotomy and survival for primary central nervous system lymphoma

Ali I. Rae, Amol Mehta, Michael Cloney, Connor J. Kinslow, Tony J.C. Wang, Govind Bhagat, Peter D. Canoll, George J. Zanazzi, Michael B. Sisti, Sameer A. Sheth, E. Sander Connolly, Guy M. Mckhann, Jeffrey N. Bruce, Fabio M. Iwamoto, Adam M. Sonabend*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


BACKGROUND Cytoreductive surgery is considered controversial for primary central nervous system lymphoma (PCNSL). OBJECTIVE To investigate survival following craniotomy or biopsy for PCNSL METHODS The National Cancer Database-Participant User File (NCDB, n = 8936), Surveillance, Epidemiology, and End Results Program (SEER, n = 4636), and an institutional series (IS, n = 132) were used. We retrospectively investigated the relationship between craniotomy, prognostic factors, and survival for PCNSL using case-control design. RESULTSIn NCDB, craniotomy was associated with increased median survival over biopsy (19.5 vs 11.0 mo), independent of subsequent radiation and chemotherapy (hazard ratio [HR] 0.80, P <.001). We found a similar trend with survival for craniotomy vs biopsy in the IS (HR 0.68, P =.15). In SEER, gross total resection was associated with increased median survival over biopsy (29 vs 10 mo, HR 0.68, P <.001). The survival benefit associated with craniotomy was greater within recursive partitioning analysis (RPA) class 1 group in NCDB (95.1 vs 29.1 mo, HR 0.66, P <.001), but was smaller for RPA 2-3 (14.9 vs 10.0 mo, HR 0.86, P <.001). A surgical risk category (RC) considering lesion location and number, age, and frailty was developed. Craniotomy was associated with increased survival vs biopsy for patients with low RC (133.4 vs 41.0 mo, HR 0.33, P =.01), but not high RC in the IS. CONCLUSION Craniotomy is associated with increased survival over biopsy for PCNSL in 3 retrospective datasets. Prospective studies are necessary to adequately evaluate this relationship. Such studies should evaluate patients most likely to benefit from cytoreductive surgery, ie, those with favorable RPA and RC.

Original languageEnglish (US)
Pages (from-to)935-944
Number of pages10
JournalClinical Neurosurgery
Issue number4
StatePublished - Apr 1 2019


  • CNS
  • Lymphoma
  • Prognosis
  • Resection
  • Survival

ASJC Scopus subject areas

  • General Medicine


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