원발성 중추신경계 림프종의 치료 성적에 대한 다기관 후향적 분석
Treatment outcomes of primary central nervous system lymphoma : Multi-center retrospective study
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목적 : 원발성 중추신경계 림프종은 그 발생빈도가 드물며 불량한 예후를 보이는 림프종의 아형으로, 치료에는 항암화학요법, 척수강내 항암화학요법제 투여 및 방사선요법 등을 이용한 복합요법이 많이 이용되고 있다. 본 연구는 다기관 후향적 분석을 통해 원발성 중추신경계 림프종의 치료성적 및 그 예후인자를 분석하고자 고안되었으며 기존의 CHOP 항암화학요법과 고용량의 methotrexate 항암화학요법 간의 치료성적을 비교하였다.방법 : 1995년부터 2003년까지 경북대학교병원, 계명대학교병원, 전남대학교병원 및 경상대학교병원에서 원발성 중추신경계 림프종으로 진단받은 58명의 환자가 포함되었다. 항암치료를 받은 56명의 환자 중 16명은 방사선요법 단일요법을 40명은 항암화학요법(CHOP 9명, 고용량 methotrexate 항암요법 31명) 및 방사선요법을 받았다.결과 : 대상 환자 중 남자가 31명(53%)이고 여자가 27명(47%)이었으며 나이는 19세에서 79세(중앙나이; 58세)까지였다. 조직 소견상 미만성 거대 B-세포형 림프종이 56예 말초 T-세포형 림프종 2예이었다. 치료 후 반응평가가 가능하였던 47명에서 완전관해 32명(68%), 부분관해 11명(23%)으로 전체반응율은 91%였다. 전체환자의 3년 생존율은 67±7.9%, 3년 무병생존율은 53±8.3%였으며, 고용량 methotrexate 항암화학요법군에서 3년 생존율 77±10% 및 3년 무병생존율 64±10%과 CHOP 항암화학요법군에서 3년 생존율 47±19%와 3년 무병생존율 31±18%의 성적을 보여 두 군간의 전체생존율은 고용량 methotrexate 항암화학요법군에서 유의한 생존율 향상을 보였다(p=0.05). 치료와 연관된 중추신경계의 합병증은 9명(21%)에서 백질뇌병증이 관찰되었다. 예후인자 분석에서 의미있는 예후인자는 확인되지 않았다.
Abstract
Background : A primary central nervous system lymphoma (PCNSL) is a rare neoplasm with a poor prognosis. The treatment of PCNSL involves a combination of chemotherapy, intrathecal chemotherapy and radiotherapy. This study retrospectively evaluated the treatment outcomes and prognostic factors of Korean patients with PCNSL. Methods : Between 1995 and 2003, 58 patients diagnosed with PCNSL from the multi-center hospitals were enrolled in this study. Among 56 patients who had received treatment, 16 patients were treated with radiotherapy alone, while 40 patients were treated with combined chemotherapy (CHOP; 9 cases, high-dose methotrexate; 31 cases) and radiotherapy. Results : The median age of the patients was 58 years (range, 19-76). A diffuse large B-cell lymphoma was diagnosed in 56 cases (96.6%), while a peripheral T-cell lymphoma was diagnosed in 2 cases. Of the 47 patients who could be assessed for their response after treatment, a CR and PR was observed in 32 (68%) and 11 patients (23%), respectively, giving an overall response rate of 91% (95% CI, 82～100%). The estimated 3-year overall survival rate for all the patients was 67±7.9% and the 3-year disease free survival rate was 53±8.3%. The overall survival of the high-dose methotrexate group was superior to that of the CHOP group (77±10% versus 47±19%, p=0.05). Leukoencephalopathy was observed as a late complication in 9 patients (21%). No significant prognostic factors affecting survival were found by univariate analysis. Conclusions : Approximately half of the patients could have long-term survival after treatment in this study. High-dose methotrexate containing chemotherapy followed by radiotherapy was found to be an effective treatment.(Korean J Med 71:654-661, 2006)
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