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 journalArticle

6 Citations (Scopus)

Abstract

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
Volume84
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Craniotomy
Lymphoma
Central Nervous System
Survival
Biopsy
SEER Program
Databases
Prospective Studies
Radiation
Drug Therapy

Keywords

  • CNS
  • Lymphoma
  • Prognosis
  • Resection
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Rae, A. I., Mehta, A., Cloney, M., Kinslow, C. J., Wang, T. J. C., Bhagat, G., ... Sonabend, A. M. (2019). Craniotomy and survival for primary central nervous system lymphoma. Clinical Neurosurgery, 84(4), 935-944. https://doi.org/10.1093/neuros/nyy096
Rae, Ali I. ; Mehta, Amol ; Cloney, Michael ; Kinslow, Connor J. ; Wang, Tony J.C. ; Bhagat, Govind ; Canoll, Peter D. ; Zanazzi, George J. ; Sisti, Michael B. ; Sheth, Sameer A. ; Connolly, E. Sander ; Mckhann, Guy M. ; Bruce, Jeffrey N. ; Iwamoto, Fabio M. ; Sonabend, Adam M. / Craniotomy and survival for primary central nervous system lymphoma. In: Clinical Neurosurgery. 2019 ; Vol. 84, No. 4. pp. 935-944.
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abstract = "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. {\circledC}",
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Rae, AI, Mehta, A, Cloney, M, Kinslow, CJ, Wang, TJC, Bhagat, G, Canoll, PD, Zanazzi, GJ, Sisti, MB, Sheth, SA, Connolly, ES, Mckhann, GM, Bruce, JN, Iwamoto, FM & Sonabend, AM 2019, 'Craniotomy and survival for primary central nervous system lymphoma', Clinical Neurosurgery, vol. 84, no. 4, pp. 935-944. https://doi.org/10.1093/neuros/nyy096

Craniotomy and survival for primary central nervous system lymphoma. / Rae, Ali I.; Mehta, Amol; Cloney, Michael; Kinslow, Connor J.; Wang, Tony J.C.; Bhagat, Govind; Canoll, Peter D.; Zanazzi, George J.; Sisti, Michael B.; Sheth, Sameer A.; Connolly, E. Sander; Mckhann, Guy M.; Bruce, Jeffrey N.; Iwamoto, Fabio M.; Sonabend, Adam M.

In: Clinical Neurosurgery, Vol. 84, No. 4, 01.04.2019, p. 935-944.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Craniotomy and survival for primary central nervous system lymphoma

AU - Rae, Ali I.

AU - Mehta, Amol

AU - Cloney, Michael

AU - Kinslow, Connor J.

AU - Wang, Tony J.C.

AU - Bhagat, Govind

AU - Canoll, Peter D.

AU - Zanazzi, George J.

AU - Sisti, Michael B.

AU - Sheth, Sameer A.

AU - Connolly, E. Sander

AU - Mckhann, Guy M.

AU - Bruce, Jeffrey N.

AU - Iwamoto, Fabio M.

AU - Sonabend, Adam M.

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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. ©

AB - 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. ©

KW - CNS

KW - Lymphoma

KW - Prognosis

KW - Resection

KW - Survival

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Rae AI, Mehta A, Cloney M, Kinslow CJ, Wang TJC, Bhagat G et al. Craniotomy and survival for primary central nervous system lymphoma. Clinical Neurosurgery. 2019 Apr 1;84(4):935-944. https://doi.org/10.1093/neuros/nyy096