All-cause and tumor-specific mortality trends in elderly primary central nervous system lymphoma (PCNSL) patients: a surveillance, epidemiology, and end results (SEER) analysis

A population based survival analysis of skull base and sacral-coccygeal chordomas in an elderly population: 2000-2021

Chordoma is an aggressive primary osseous tumor that most often arises from the sacral-coccygeal region and the skull base. Treatment typically requires en bloc gross total resection necessitating significant iatrogenic tissue disruption and physiological stress making management in a vulnerable elderly cohort challenging. The Surveillance, Epidemiology, and End Results (SEER) database was employed to isolate cases of chordoma in patients 65+ years of age between the years 2000-2021. Kaplan Meier survival analyses were used to identify survival trends. Multivariate cox regression analysis controlled for confounding variables. A subgroup analysis comparing geriatric survival to an adult cohort was performed. A total of 380 cases (128 skull base, 252 sacral-coccygeal) were included. Surgery not performed improved cumulative tumor-specific survival in both univariate and multivariate analyses (HR = 0.49, 95 % CI [0.27-0.88], p = 0.016), but surgery did not impact cumulative all-cause survival nor primary site-specific all-cause survival. Geriatric survival (89.2 ± 4.6 months) was significantly shorter than adult survival (187.6 ± 4.9 months) in subgroup analysis (p < 0.001). Year of diagnosis did not significantly impact survival. Minimal improvements in geriatric chordoma survival have been made over the last two decades. Worsened tumor-specific survival with surgery likely results from the need for resection of advanced disease that inherently carries high risk within this population and surgery being deferred in the event of less advanced disease. Further study is needed to improve medical and surgical therapies within this cohort to improve survival.

Geriatric patients undergo surgery less and have worse survival outcomes with intramedullary ependymoma: A surveillance, epidemiology, and end results database analysis

OBJECTIVE

Intramedullary ependymomas account for ∼50 % of all primary tumors in the spinal cord. Though gross total resection has become mainstay, other predictors of survival remain poorly characterized. The present study aims to perform a survival analysis and compare prognostic factors across pediatric, adult and geriatric cohorts.

METHODS

The Surveillance, Epidemiology, and End Results database was employed to isolate cases of intramedullary ependymomas from 2000 to 2021. Cases were grouped based on age: 0-19 years=pediatric, 20-64 years=adult, 65 + years=geriatric. Kaplan Meier followed by multivariate cox regression analyses were used to identify survival trends. Univariate comparison analyses compared age cohorts.

RESULTS

2045 cases were included. Geriatric patients demonstrate increased risk of mortality (pediatric vs geriatric: HR=0.23, CI [0.13-0.39], p < 0.001; adult vs geriatric: HR=0.18, CI [0.15-0.23], p < 0.001). Compared to adult patients (92.7 %), geriatric patients (85.2 %) underwent significantly less surgery (p < 0.001). Sex did not influence pediatric or geriatric survival nor did surgery statistically impact pediatric survival, but otherwise surgery not performed, male patients and grade III tumors significantly worsened overall and age-specific survival. Surgery performed in a pediatric patient led to a longer mean survival of 19.8 months, which is clinically relevant despite not meeting statistical significance. Year of diagnosis did not impact overall (p = 0.79) nor age-specific survival (pediatric: p = 0.98, adult: p = 0.91, geriatric: p = 0.11).

CONCLUSIONS

Geriatric patients suffer from worse survival than those of younger age. Surgery decreases mortality, yet less geriatric patients are receiving surgical resection. No significant survival gains have been made over the last two decades among any age. Further study is needed to optimize medical management to compliment surgical resection and surgery should be considered more often in geriatric patients to improve survival.

Conditional survival of elderly primary central nervous system lymphoma

BACKGROUND

Recent studies have reported that overall survival of elderly patients with primary central nervous system lymphoma (PCNSL), who have the highest incidence of this disease, had failed to benefit from the advancements in treatment strategies over the past decades. This highlights the necessity for intensified research to guide treatment decisions for this specific patient population.

METHODS

The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI) was used to extract data of elderly PCNSL patients (age ≥ 60) who were divided into training and validation groups at the ratio of 7:3, for our analysis. Conditional survival [CS(y|x)] was defined as the probability at survival additional y years given that the patient had not died of PCNSL at a specified period of time (x years) after initial diagnosis. The CS pattern of elderly PCNSL patients was analyzed. The least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression analysis were applied to develop a novel CS-based nomogram.

RESULTS

A total of 3315 elderly patients diagnosed with CNS lymphoma between 2000 and 2019 were extracted from the SEER database, of whom 2320 patients were divided into the training group and 995 into the internal validation group. CS analysis revealed a noteworthy escalation in the 5-year survival rate among elderly PCNSL patients for every additional year of survival. The rates progressed from an initial 21-49%, 63%, and 75%, culminating in an impressive 88% and the survival improvement over time was nonlinear. The LASSO regression identified nine predictors and multivariate Cox regression was used to successfully construct the CS-based nomogram model with favorable prediction performance.

CONCLUSION

CS of elderly PCNSL patients was dynamic and increased over time. Our newly-established CS-based nomogram can provide a real-time dynamic survival estimation, allowing clinicians to better guide treatment decision for these patients.

Primary central nervous system lymphoma high incidence and poor survival in Finnish population-based analysis

Background

We report here the first population-based incidence rates and prognosis of primary central nervous system lymphoma (PCNSL) in Finland.

Methods

Finnish Cancer Registry data by histological diagnosis and tumor location (2007–2017) for cases with diffuse large B-cell lymphoma.

Results

During 2007–2017, 392 new cases of PCNSL were reported (195 males, 197 females). The average age-adjusted incidence was 0.68/100,000 person-years. Incidence for males was 0.74/100,000 and for females 0.63/100,000, respectively. The incidence was highest, 2.93/100,000, among people aged 75–79 years. Concerning all cases in 2007–2017 the 2-year age-adjusted relative survival rate was 33% and the corresponding 5-year survival rate was 26%. Among patients under the age of 70, the age-adjusted 5-year relative survival rate increased from 36% in 2007–2012 to 43% for 2013–2017. Among patients aged 70+ the corresponding survival rates were poor, 7 and 9%.

Conclusions

PCNSL incidence in Finland is among the highest reported in the world. The annual increase in incidence was 2.4%. The prognosis is still dismal, especially in elderly patients.

Differentiation between primary CNS lymphoma and atypical glioblastoma according to major genomic alterations using diffusion and susceptibility-weighted MR imaging

PURPOSE

We aimed to differentiate primary central nervous system lymphoma (PCNSL) from atypical glioblastoma (GB) and distinguish major genomic subtypes between these tumors using susceptibility-weighted imaging (SWI) along with diffusion-weighted imaging (DWI).

METHODS

Thirty-one immuno-competent patients with PCNSL stratified by BCL2 and MYC rearrangement, and 57 patients with atypical GB (no visible necrosis) grouped according to isocitrate dehydrogenase-1 (IDH1) mutation status underwent 3.0-Tesla MRI before treatment in this retrospective study. Region of interest analysis with apparent diffusion coefficient (ADC) and SWI signal intensity values of the tumors were normalized by dividing those of contralateral white matter. The independent-samples t-test and Kruskal-Wallis test were utilized to compare parameters. The diagnostic ability of each parameter and their optimal combination was evaluated by logistic regression analysis and receiver operating characteristic.

RESULTS

PCNSL with rearrangement of both MYC and BCL2 (n = 7) [mean relative (r) ADCmean:0.87 ± 0.06, rADCmin:0.72 ± 0.08] demonstrated significantly lower rADCmean, and rADCmin compared to other PCNSLs (n = 24) (rADCmean:1.19 ± 0.18, rADCmin:1.03 ± 0.17;p < 0.001) and GBs (p < 0.001). GB without IDH1 mutation (n = 44) (mean rSWI value:0.95 ± 0.15) demonstrated significantly lower rSWI value compared to GB with IDH1 mutation (n = 13) (rSWI value:1.13 ± 0.09;p < 0.001) and PCNSL (p < 0.001). The incorporation of rADCmean and rSWI parameters distinguished GB with IDH1 mutation [Area under the curve (AUC):0.985] with sensitivity and specificity of 94.3 and 100 % respectively; and PCNSL with rearrangement of both MYC and BCL2 (AUC:0.982) with sensitivity and specificity of 100 % and 95.4 %, respectively. CONCLUSıONS: Combined analysis of SWI and DWI could differentiate atypical GB from PCNSL and distinguish major genomic subtypes between these tumors.