RESEARCH—HUMAN—CLINICAL STUDIES

Craniotomy and Survival for Primary Central Nervous System Lymphoma

Rae, Ali I BS; Mehta, Amol BA; Cloney, Michael MD, MPH; Kinslow, Connor J BS; Wang, Tony J C MD; Bhagat, Govind MD; Canoll, Peter D MD, PhD; Zanazzi, George J MD, PhD; Sisti, Michael B MD; Sheth, Sameer A MD, PhD; Connolly, E Sander MD; McKhann, Guy M MD; Bruce, Jeffrey N MD; Iwamoto, Fabio M MD; Sonabend, Adam M MD

Author Information

Warren Alpert Medical School, Brown University, Providence, Rhode Island

De-partment of Health Policy, Mailman School of Public Health, Columbia Univer-sity, New York, New York

School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania

Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois

College of Physicians and Surgeons, Columbia University, New York, New York

Department of Radi-ation Oncology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York

Department of Pathology and Cell Biology, College of Physicians and Sur-geons, Columbia University Medical Center, New York, New York

Depart-ment of Neurological Surgery, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York

Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York

Correspondence: Adam M. Sonabend, MD, Department of Neurosurgery, Northwestern University, Feinberg School of Medicine, 676 N St. Clair Street, Suite 2210, Chicago IL 60611. E-mail: [email protected]

These authors contributed equally to this work.

Neurosurgery 84(4):p 935-944, April 2019. | DOI: 10.1093/neuros/nyy096

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.

RESULTS

In 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.

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Craniotomy and Survival for Primary Central Nervous System Lymphoma