Abstract
The efficacy of currently available treatments for Hodgkin's disease (HD) has led to a substantial modification in the prognosis of this disease; nevertheless there is still a group of patients that cannot be cured with conventional treatments and who will be candidates for alternative therapy. In the present work we analysed the prognostic influence of the most relevant clinico-biological characteristics of HD in a consecutive series of 137 patients diagnosed and treated in a single institution. Univariate analyses identified six variables with significant prognostic influence, both on achieving complete remission (CR) and overall survival (OS); LDH > 320 U ml-1, age > 45 years, stages IIB, III and IV, extranodal involvement, alkaline phosphatase > 190 UI dl and ESR > 40 mm h. In addition, Hb < 12.5 gr dl-1 and abdominal disease were statistically relevant for CR while a poor performance score (ECOG > or = 2) affected a lower survival. In the multivariate analysis only LDH, age and the clinical stage retained a significant prognostic influence for achieving CR, while the two first factors above, together with performance status were the variables with independent prognostic value with respect to OS. Moreover, only LDH > 320 U ml-1 had prognostic influence in the probability of relapse and disease free survival (DFS), both in the univariate and multivariate analyses. According to the three independent factors obtained in the multivariate analysis for CR (LDH, age and stage) a predictive model was established that allows the stratification of patients into two prognostic groups: one with poor prognosis that includes patients with the three adverse prognostic factors, or two if one of them was elevated LDH, and the other with good prognosis that includes the remaining patients. This model was also able to separate two independent groups of patients with respect to OS and to DFS. In conclusion, the present study shows that LDH is one of the most important prognostic factors in HD.
Highlights
Abdominal involvement was defined as the presence of disease in any part of the abdomen detected by: (a) physical examination; (b) radiological methods or (c) histologic demonstration by percutaneous biopsy or laparotomy
In most patients (81%) Hodgkin's disease (HD) was in the advanced stages
The efficacy of currently available treatments against HD have led to a substantial modification in the prognosis of this disease; there is still one group of patients that cannot be cured with conventional treatments
Summary
Clinical staging was performed according to the indications of the Ann Arbor conference (Carbone et al, 1971) and the Cotswolds review (Lister et al, 1989). All the early stages (I and IIA) were confirmed by Kaplan laparotomy. Abdominal involvement was defined as the presence of disease in any part of the abdomen detected by: (a) physical examination (unequivocally palpable spleen or equivocally palpable spleen plus radiologic enlargement or esplenic defects); (b) radiological methods (lymph nodes or masses > 1.5 cm or nodes in the liver or spleen, if found in the liver they should be confirmed by two different methods) or (c) histologic demonstration by percutaneous biopsy or laparotomy. Histological classification was made according to the Rye modification of the Lukes and Butler scheme (Lukes et al, 1966)
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