Enhanced clinical outcomes with radiotherapy in diagnostically challenging intracranial plasmacytomas: Analysis of 190 cases

Author:

Feng Yuan12345,Zhang Zongpu12345,Qiu Fufang12345,Yang Zixiao12345,Xiong Ji6,Zhu Wei12345,Wan Fangzhu78,Chen Bobin9,Wang Jiguang101112,Zhang Yi12345,Hua Wei12345ORCID

Affiliation:

1. Department of Neurosurgery, Huashan Hospital Fudan University Shanghai China

2. National Center for Neurological Disorders Shanghai China

3. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration Shanghai China

4. Neurosurgical Institute of Fudan University Shanghai China

5. Shanghai Clinical Medical Center of Neurosurgery Shanghai China

6. Department of Pathology, Huashan Hospital Fudan University Shanghai China

7. Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center Fudan University Cancer Hospital Shanghai China

8. Shanghai Key Laboratory of Radiation Oncology (20dz2261000) Shanghai China

9. Department of Hematology, Huashan Hospital Fudan University Shanghai China

10. Division of Life Science, Department of Chemical and Biological Engineering, and State Key Laboratory of Molecular Neuroscience The Hong Kong University of Science and Technology Hong Kong SAR China

11. SIAT‐HKUST Joint Laboratory of Cell Evolution and Digital Health HKUST Shenzhen‐Hong Kong Collaborative Innovation Research Institute Shenzhen China

12. Hong Kong Center for Neurodegenerative Diseases, InnoHK Hong Kong SAR China

Abstract

AbstractBackgroundIntracranial plasmacytomas are rare tumors arising from plasma cells with approximately half of the cases progressing to multiple myeloma (MM). However, there is a lack of comprehensive clinical cohort analysis on the clinical and pathological features, progression, and outcomes of intracranial plasmacytomas.MethodsA retrospective analysis of 190 cases was conducted, combining data from 38 cases in a single institution and 152 cases from the literature. Patient demographics, clinical presentations, tumor locations, imaging features, surgical treatments, and follow‐up outcomes were collected and analyzed. Survival analysis and Cox regression analysis were performed to identify prognostic factors.ResultsA total of 190 intracranial plasmacytoma patients with an average age of 55.4 years were included in the study. The preoperative misdiagnosis ratio was high at 55.3%, and 59.7% of the tumors affected the calvaria convexity, compared to 40.3% located at the skull base. Resection and biopsy were achieved in 72.4% and 27.6% patients, respectively. Among them, 34.2% (65/190) of patients were initially diagnosed with MM with intracranial plasmacytoma as their first presentation (MM‐IPFP), while 63.2% (120/190) of patients were diagnosed with solitary intracranial plasmacytoma (SIP), including 61 extramedullary plasmacytomas and 59 solitary bone plasmacytomas. In the SIP group, 22.4% (24/107) of patients experienced disease progression leading to the development of MM during a median follow‐up time of 42.6 months (range 1–230 months). Multivariate analysis unveiled that radiotherapy (HR, 0.05; 95% CI, 0.00–0.87; p = 0.04), not surgery, was a protective prognostic factor for overall survival in MM‐IPFP patients. Comparison between the SIP progression group and non‐progression group revealed a significant difference of Ki‐67 index (non‐progression vs. SIP progression, 8.82% ± 7.03 vs. 16.5% ± 10.5, p < 0.05). AUC analysis determined that a cutoff value of 9.0% was the best predictor of SIP progression, with an area under the curve of 0.712.ConclusionsThis retrospective clinical analysis highlights the potential role of radiotherapy, rather than surgical resection, in improving the outcomes of intracranial plasmacytoma. Additionally, the Ki‐67 index is identified as a valuable marker for predicting disease progression. This would provide some evidence for the paradigm of diagnosis and treatment modalities for intracranial plasmacytomas from the large cohort.

Funder

National Natural Science Foundation of China

Publisher

Wiley

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