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Nomograms Predict Survival Outcome of Primary Intramedullary Spinal Cord Lymphoma Patients

Qiong Wu, Zuyi Yang, Yuan Xu

(Department of Radiation Oncology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland))

Med Sci Monit 2019; 25:7418-7429

DOI: 10.12659/MSM.919628


BACKGROUND: Primary intramedullary spinal cord lymphoma (PISCL) is a rare cause of myelopathies. Considering its poor prognosis, it is essential to determine the appropriate treatment strategies and to develop nomograms to predict survival outcome for PISCL patients.
MATERIAL AND METHODS: Data were collected from the Surveillance, Epidemiology and End Results (SEER) database. We used 364 patients to investigate overall survival (OS) and 289 patients for cancer-specific survival (CSS). Kaplan-Meier method was to evaluate correlations of survival with different treatment strategies and clinicopathologic factors. Univariate and multivariable analyses were conducted to assess OS and CSS based on different variables. Risk factors were integrated to build nomograms.
RESULTS: Most of the 414 PISCL patients diagnosed with positive histology had diffuse B cell lymphoma, were under 60 years old, were male, were of white race, had 1 primary tumor, were married, were low stage, and had previously undergone chemotherapy. We found that radiation therapy had no effect on patient OS and CSS, and patients receiving chemotherapy alone tended to have better OS and CSS in comparison with other groups. In addition, we showed that clinicopathologic factors, including histologic type, age, stage, and marital status, could serve as independent prognostic factors for PISCL patient OS and CSS. These factors were utilized to construct nomograms. The calibration curves demonstrated good agreement. The concordance indexes for OS and CSS were 0.672 (P=0.024) and 0.683 (P=0.029), respectively.
CONCLUSIONS: Practical nomograms were established for patients’ OS and CSS. Besides, this study can guild clinician to make the right decision for appropriate treatment of PISCL patients.

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