Blood Res.  2020 Jun;55(2):99-106. 10.5045/br.2020.2020032.

Apparent diffusion coefficient as a valuable quantitative parameter for predicting clinical outcomes in patients with newly diagnosed primary CNS lymphoma

• Baek DW
• Cho HJ
• Bae JH
• Sohn SK
• Moon JH

• KMID: 2503484
• DOI: http://doi.org/10.5045/br.2020.2020032

Abstract

Background
This study attempted to identify novel prognostic factors in patients with newly diagnosed primary central nervous system lymphoma (PCNSL) using magnetic resonance imaging (MRI).
Methods
We retrospectively evaluated 67 patients diagnosed with central nervous system (CNS) tumors. The enrollment criteria were as follows: i) pathologic diagnosis of CNS lymphoma, ii) no evidence of systemic involvement, iii) no evidence of human immunodeficiency virus-1 infection or other immunodeficiencies, and iv) MRI scans available at diagnosis. Fifty-two patients met these criteria and were enrolled.
Results
The 3-year overall survival (OS) and failure-free survival rates were 69.7% and 45.6%, respectively, with a median follow-up duration of 36.2 months. OS of patients with low apparent diffusion coefficient (ADC) was lower than those with higher ADC. Multivariate analysis revealed that old age (＞60 yr) [hazard ratio (HR), 20.372; P=0.001], Eastern Cooperative Oncology Group performance status (ECOG PS) ≥2 (HR, 10.429; P ＜ 0.001), higher lactate dehydrogenase (LDH) levels (HR, 7.408; P =0.001), and low ADC (HR, 0.273; P=0.009) were associated with lower OS. We modified the conventional prognostic scoring system using low ADC, old age (＞60 yr), ECOG PS ≥2, and higher LDH. The risk of death was categorized as high (score 3-4), intermediate-2 (score 2), intermediate- 1 (score 1), and low (score 0), with three-year OS rates of 33.5%, 55.4%, 88.9%, and 100%, respectively.
Conclusion
ADC demonstrated significant prognostic value for long-term survival in patients with newly diagnosed PCNSL. Low ADC was an independent unfavorable prognostic factor, suggesting that ADC obtained from MRI can improve the current prognostic scoring system.

Keyword

Lymphoma; Central nervous system; Prognosis; Magnetic resonance imaging

Figure

• 

  Fig. 1 Kaplan-Meier curves for overall survival (OS). Patients with low ADC had lower OS (P=0.005) (A), while patients with tumors measuring less than 5 cm exhibited a tendency toward better OS (P=0.055) (B). Abbreviation: ADC, apparent diffusion coefficient.

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  Fig. 2 Kaplan-Meier curves for failure-free survival (FFS). Patients with hyperintense signal on T2-weighted imaging (P=0.001) (A) and homogenous enhancement (P=0.011) (B) had better FFS, while patients with low ADC (P=0.018) (C) and necrosis had poor FFS (P<0.001) (D). Abbreviation: ADC, apparent diffusion coefficient.

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  Fig. 3 Modified prognostic scoring system. The prognostic scoring system comprising old age, ECOG PS, and LDH (A) and the modified scoring system comprising old age, ECOG PS, LDH, and ADC (B). Abbreviations: ADC, apparent diffusion coefficient; ECOG PS, Eastern Cooperative Oncology Group performance status; LDH, lactate dehydrogenase.

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