Surgical resection versus biopsy in the treatment of primary central nervous system lymphoma: a systematic review and meta-analysis.

Autor: Chojak R; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland. rafalchojak@gmail.com.; Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland. rafalchojak@gmail.com., Koźba-Gosztyła M; Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland., Polańska K; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Rojek M; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Chojko A; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Bogacz R; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Skorupa N; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Więcław J; Faculty of Medicine, Wroclaw Medical University, Ludwika Pasteura 1, 50-367, Wrocław, Poland., Czapiga B; Department of Neurosurgery, 4th Military Hospital in Wroclaw, Wrocław, Poland.; Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2022 Dec; Vol. 160 (3), pp. 753-761. Date of Electronic Publication: 2022 Nov 30.
DOI: 10.1007/s11060-022-04200-7
Abstrakt: Purpose: Despite the improvement in treatment and prognosis of primary central nervous system lymphoma (PCNSL) over the last decades, the 5-year survival rate is approximately 30%; thus, new therapeutic approaches are needed to improve patient survival. The study's aim was to evaluate the role of surgical resection of PCNSL.
Methods: Primary outcomes were the overall survival (OS) and progression-free survival (PFS) of patients with PCNSL who underwent surgical resection versus biopsy alone. The meta-analysis was conducted to calculate pooled hazard ratios (HRs) under a random-effects model for the time-to-event variables. The odds ratios (ORs) were calculated for binary, secondary outcome parameters.
Results: Seven studies (n = 1046) were included. We found that surgical resection was associated with significantly better OS (HR 0.63 [95% CI 0.51-0.77]) when compared with biopsy. PFS was also significantly improved (HR 0.64 [95% CI 0.49-0.85]) in patients who underwent resection compared with those who underwent biopsy. The heterogeneity for OS and PFS was low (I2 = 7% and 24%, respectively). We also found that patients who underwent biopsy more often had multiple (OR 0.38 [95% CI 0.19-0.79]) or deep-seated (OR 0.20 [95% CI 0.12-0.34]) lesions compared with those who underwent surgical resection. There were no significant differences in chemotherapy or radiotherapy use or the occurrence of postoperative complications between the two groups.
Conclusion: In selected patients, surgical resection of PCNSL is associated with significantly better overall survival and progression-free survival compared with biopsy alone.
(© 2022. The Author(s).)
Databáze: MEDLINE
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