Удаление опухоли головного мозга при лимфоме показало преимущество перед биопсией, но эффект зависит от локализации

Resection was associated with longer overall survival than stereotactic biopsy among selected adults with primary central nervous system lymphoma (PCNSL), although the association was attenuated after adjustment for deep tumor location and multifocal disease, according to a study published in Clinical Neurology and Neurosurgery. A single-center retrospective study also found that radiological tumor regression before diagnosis, or “vanishing tumor,” occurred in 21% of patients, which markedly prolonged the diagnostic interval and was independently associated with increased mortality. This analysis included 56 adults with histopathologically confirmed PCNSL treated between January 2015 and April 2023 at the Institute of Psychiatry and Neurology in Warsaw. The mean age was 66 years (range, 23-82), and 30 patients (54%) were women. B-cell lymphoma accounted for 55 cases; 1 patient had extranodal marginal zone lymphoma of the dura mater. Forty patients (71%) underwent stereotactic biopsy, and 16 (29%) underwent craniotomy with resection, including gross total resection in 9/16 (56%). Median overall survival was 465 days (IQR, 302-1069) after resection vs 149.5 days (IQR, 72-526) after biopsy, with significant separation by Kaplan-Meier analysis (log-rank P =.029). Univariable Cox regression showed lower mortality with resection (HR, 0.419; 95% CI, 0.187-0.938; P =.034), as did adjustment for age and sex (HR, 0.432; 95% CI, 0.192-0.972; P =.043). However, additional adjustment for deep location and multifocal disease reduced the association to nonsignificance (HR, 0.451; 95% CI, 0.195-1.041; P =.062), underscoring potential selection and residual confounding. The vanishing tumor phenomenon was identified in 12 patients (21%). These patients had a median diagnostic interval of 82 days compared with 9 days among those without tumor regression (P <.001). Median overall survival was also shorter with vanishing tumor, at 149.5 vs 356 days, although the unadjusted difference was not statistically significant (P =.313). In multivariable Cox analysis, however, vanishing tumor was associated with nearly 3-fold higher mortality (HR, 2.952; 95% CI, 1.219-7.145; P =.016). Procedure-related complications occurred in 5 patients (9%). Intracranial hemorrhage occurred in 3 patients (5%), all following biopsy; no hemorrhagic complications occurred after resection. Two serious nonhemorrhagic events followed craniotomy, including postoperative status epilepticus and worsening hemiparesis that limited subsequent oncological treatment. No perioperative deaths occurred. The findings support individualized consideration of resection when PCNSL lesions are surgically accessible but do not establish a causal survival benefit over biopsy. More immediately, the high frequency and diagnostic consequences of vanishing tumor reinforce the need to minimize prediagnostic corticosteroid exposure when clinically feasible. Steroids should therefore be reserved for clear clinical necessity in patients with suspected PCNSL to reduce the risk of radiological regression and potentially substantial diagnostic delay. “Timely histopathological confirmation and early initiation of oncological treatment remain critical for effective PCNSL management,” stated the authors. “Prospective studies in larger cohorts are warranted to validate patient selection criteria and to clarify the roles of surgery and corticosteroid exposure in PCNSL care.” This article originally appeared on Rare Disease Advisor References: Glinka P, Sobstyl M, Rymkiewicz G, Ostrowska B, Acewicz A, Karamon K. Primary CNS lymphoma: survival after craniotomy with resection versus stereotactic biopsy and the clinical impact of the “vanishing tumor” phenomenon. Clin Neurol Neurosurg. Published online August 1, 2026. doi:10.1016/j.clineuro.2026.109595