Time matters: the prognostic impact of diagnostic delay on survival in primary central nervous system lymphoma—a single-center, retrospective real-world study Article Swipe

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Louisa Lehner , Louisa von Baumgarten , Jonas Reis , Abdul Qayyum Khan , Kim-Fabienne Degmayr , Benjamin Englert , Andreas Straube , Martin Dreyling , Veit Stöcklein , Patrick N. Harter , Niklas Thon , Stefanie Quach , Katharina Müller ·

YOU? · · 2025 · Open Access · · DOI: https://doi.org/10.1093/noajnl/vdaf234

Background Primary central nervous system lymphoma (PCNSL) is a rare and aggressive malignancy that frequently mimics other central nervous system (CNS) diseases, leading to diagnostic delays. Given its often nonspecific radiological presentation, PCNSL remains a diagnostic challenge, however early diagnosis and timely initiation of treatment are critical. This study aimed to evaluate diagnostic timelines and their influencing factors, treatment patterns, and their impact on survival in patients with PCNSL. Methods We retrospectively analyzed 125 patients diagnosed with PCNSL at a single tertiary care referral center between 2008 and 2021. Clinical, radiological, and histopathological data were collected to assess factors influencing diagnostic delay, treatment decisions, and patient outcomes. Results The median age at diagnosis was 68 years (21-89) and median Karnofsky Performance Status (KPS) was 70% (10-100). The median time from initial clinical symptom to histopathologically confirmed diagnosis was 37 days (4-749). The median time from first neuroimaging to confirmed diagnosis was 12 days (2-225). A shorter diagnostic interval (≤12 days) was associated with significantly improved overall survival (OS) and progression-free survival (PFS) (p < 0.05). In a multivariate Cox proportional hazards model, predictors of OS were KPS ≥70% (p < 0.003), preserved renal function (GFR > 60 mL/min, p < 0.027), and MTX-based chemotherapy (p < 0.001). Further, diagnostic delay (>12days) emerged as an independent predictor of PFS (p < 0.024). Conclusion Our study underscores the prognostic impact of diagnostic delay in PCNSL. Renal function and KPS emerged as independent OS markers. MTX-based chemotherapy remains the standard of care, with ASCT providing best survival outcomes in eligible patients.

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Type: article
Language: en
Landing Page: https://doi.org/10.1093/noajnl/vdaf234
OA Status: gold
OpenAlex ID: https://openalex.org/W4416109799

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DOI: https://doi.org/10.1093/noajnl/vdaf234

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Title: Time matters: the prognostic impact of diagnostic delay on survival in primary central nervous system lymphoma—a single-center, retrospective real-world study

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Language: en

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Publication year: 2025

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Publication date: 2025-10-23

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Authors: Louisa Lehner, Louisa von Baumgarten, Jonas Reis, Abdul Qayyum Khan, Kim-Fabienne Degmayr, Benjamin Englert, Andreas Straube, Martin Dreyling, Veit Stöcklein, Patrick N. Harter, Niklas Thon, Stefanie Quach, Katharina Müller

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Landing page: https://doi.org/10.1093/noajnl/vdaf234

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abstract_inverted_index.care	83
abstract_inverted_index.data	94
abstract_inverted_index.days	140, 153
abstract_inverted_index.from	130, 145
abstract_inverted_index.rare	10
abstract_inverted_index.that	14
abstract_inverted_index.time	129, 144
abstract_inverted_index.were	95, 186
abstract_inverted_index.with	68, 77, 163, 250
abstract_inverted_index.(CNS)	21
abstract_inverted_index.(KPS)	123
abstract_inverted_index.(PFS)	172
abstract_inverted_index.2021.	89
abstract_inverted_index.Given	27
abstract_inverted_index.PCNSL	33, 78
abstract_inverted_index.Renal	234
abstract_inverted_index.aimed	50
abstract_inverted_index.care,	249
abstract_inverted_index.days)	160
abstract_inverted_index.delay	210, 231
abstract_inverted_index.early	39
abstract_inverted_index.first	146
abstract_inverted_index.often	29
abstract_inverted_index.other	17
abstract_inverted_index.renal	193
abstract_inverted_index.study	49, 224
abstract_inverted_index.their	56, 62
abstract_inverted_index.years	116
abstract_inverted_index.(≤12	159
abstract_inverted_index.0.05).	175
abstract_inverted_index.PCNSL.	69, 233
abstract_inverted_index.Status	122
abstract_inverted_index.assess	98
abstract_inverted_index.center	85
abstract_inverted_index.delay,	102
abstract_inverted_index.impact	63, 228
abstract_inverted_index.median	110, 119, 128, 143
abstract_inverted_index.mimics	16
abstract_inverted_index.model,	182
abstract_inverted_index.single	81
abstract_inverted_index.system	5, 20
abstract_inverted_index.timely	42
abstract_inverted_index.≥70%	188
abstract_inverted_index.(21-89)	117
abstract_inverted_index.(PCNSL)	7
abstract_inverted_index.0.001).	207
abstract_inverted_index.0.003),	191
abstract_inverted_index.0.024).	221
abstract_inverted_index.0.027),	201
abstract_inverted_index.Methods	70
abstract_inverted_index.Primary	2
abstract_inverted_index.Results	108
abstract_inverted_index.between	86
abstract_inverted_index.central	3, 18
abstract_inverted_index.delays.	26
abstract_inverted_index.emerged	212, 238
abstract_inverted_index.factors	99
abstract_inverted_index.hazards	181
abstract_inverted_index.however	38
abstract_inverted_index.initial	131
abstract_inverted_index.leading	23
abstract_inverted_index.mL/min,	198
abstract_inverted_index.nervous	4, 19
abstract_inverted_index.overall	166
abstract_inverted_index.patient	106
abstract_inverted_index.remains	34, 245
abstract_inverted_index.shorter	156
abstract_inverted_index.symptom	133
abstract_inverted_index.&gt;	196
abstract_inverted_index.&lt;	174, 190, 200, 206, 220
abstract_inverted_index.(2-225).	154
abstract_inverted_index.(4-749).	141
abstract_inverted_index.Abstract	0
abstract_inverted_index.Further,	208
abstract_inverted_index.analyzed	73
abstract_inverted_index.clinical	132
abstract_inverted_index.eligible	257
abstract_inverted_index.evaluate	52
abstract_inverted_index.factors,	58
abstract_inverted_index.function	194, 235
abstract_inverted_index.improved	165
abstract_inverted_index.interval	158
abstract_inverted_index.lymphoma	6
abstract_inverted_index.markers.	242
abstract_inverted_index.outcomes	255
abstract_inverted_index.patients	67, 75
abstract_inverted_index.referral	84
abstract_inverted_index.standard	247
abstract_inverted_index.survival	65, 167, 171, 254
abstract_inverted_index.tertiary	82
abstract_inverted_index.(10-100).	126
abstract_inverted_index.Clinical,	90
abstract_inverted_index.Karnofsky	120
abstract_inverted_index.MTX-based	203, 243
abstract_inverted_index.collected	96
abstract_inverted_index.confirmed	136, 149
abstract_inverted_index.critical.	47
abstract_inverted_index.diagnosed	76
abstract_inverted_index.diagnosis	40, 113, 137, 150
abstract_inverted_index.diseases,	22
abstract_inverted_index.outcomes.	107
abstract_inverted_index.patients.	258
abstract_inverted_index.patterns,	60
abstract_inverted_index.predictor	216
abstract_inverted_index.preserved	192
abstract_inverted_index.providing	252
abstract_inverted_index.timelines	54
abstract_inverted_index.treatment	45, 59, 103
abstract_inverted_index.Background	1
abstract_inverted_index.Conclusion	222
abstract_inverted_index.aggressive	12
abstract_inverted_index.associated	162
abstract_inverted_index.challenge,	37
abstract_inverted_index.decisions,	104
abstract_inverted_index.diagnostic	25, 36, 53, 101, 157, 209, 230
abstract_inverted_index.frequently	15
abstract_inverted_index.initiation	43
abstract_inverted_index.malignancy	13
abstract_inverted_index.predictors	183
abstract_inverted_index.prognostic	227
abstract_inverted_index.Performance	121
abstract_inverted_index.independent	215, 240
abstract_inverted_index.influencing	57, 100
abstract_inverted_index.nonspecific	30
abstract_inverted_index.underscores	225
abstract_inverted_index.chemotherapy	204, 244
abstract_inverted_index.multivariate	178
abstract_inverted_index.neuroimaging	147
abstract_inverted_index.proportional	180
abstract_inverted_index.radiological	31
abstract_inverted_index.presentation,	32
abstract_inverted_index.radiological,	91
abstract_inverted_index.significantly	164
abstract_inverted_index.retrospectively	72
abstract_inverted_index.(&gt;12days)	211
abstract_inverted_index.progression-free	170
abstract_inverted_index.histopathological	93
abstract_inverted_index.histopathologically	135
cited_by_percentile_year
countries_distinct_count	1
institutions_distinct_count	13
citation_normalized_percentile