Infradiaphragmatic versus supradiaphragmatic Hodgkin lymphoma: a retrospective review of 1114 patients
Infradiaphragmatic versus supradiaphragmatic Hodgkin lymphoma: a retrospective review of 1114 patients
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DOI：
10.1080/10428190500144847
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发表时间：
2005-12-01
影响因子：
2.6
通讯作者：
Diehl, V
中科院分区：
文献类型：
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作者：
Darabi, K;Sieber, M;Diehl, V
膈下霍奇金淋巴瘤 (IDH) 占 I-II 期霍奇金淋巴瘤 (HD) 病例的 4-13%。与膈上 HD (SDH) 相比，它与独特的治疗前特征和结果相关。 IDH 与 SDH 的比较只能在早期和中期（I-II）进行，对于晚期（III-IV）不可能进行这种比较。本研究回顾性比较了两组 1013 名 I-II 期 SDH 患者和 101 名 IDH 患者（10%）。 1988 年至 1993 年，德国针对早期和中期霍奇金淋巴瘤进行了两项前瞻性随机临床试验，对这两个亚组患者进行了治疗。 IDH 患者年龄较大（中位 39 岁 vs 31 岁；p < 50.001），主要为男性（73% vs 52%；p < 50.001），并且更常累及 53 个淋巴结区域 (LNA)（80% vs 55%；p < 50.001）。 IDH 的组织学更有可能是混合细胞结构（46.5% vs 23.6%，p < 50.001）或淋巴细胞为主（20 vs 10%，p = 0.003），结节性硬化的可能性较小（25% vs 63%，p < 50.001）。在早期不利疾病中，IDH 与较高的治疗失败率相关（未经调整的风险比 2，95% CI，1.3-3.4；p = 0.003）。在控制年龄、性别、分期、组织学、B 症状和 53 个 LNA 受累后，调整后的风险比为 1.25（95% CI，0.65-2.4；p = 0.51），因此 IDH 不再与具有统计学意义的治疗失败率相关。与 SDH 相比，IDH 的预后较差，这是因为它与已知的不良预后风险因素相关，但 IDH 本身并不是治疗失败或生存的独立不良预后因素。
Infradiaphragmatic Hodgkin lymphoma (IDH) accounts for 4-13% of cases of stage I-II Hodgkin lymphoma (HD). It has been associated with distinct pre-treatment characteristics and outcomes when compared with supradiaphragmatic HD (SDH). The comparison of IDH vs SDH can only be made in early and intermediate stages (I-II), such a comparison is not possible for advanced stages (III-IV). This study retrospectively compared two groups of 1013 patients with stage I-II SDH and 101 patients with IDH (10%). These two sub-groups of patients were treated in 1988 - 1993 in 2 prospective randomized clinical trials in Germany for early and intermediate stages of Hodgkin lymphoma. IDH-patients were older (median 39 vs 31 years; p < 50.001), predominantly male (73% vs 52%; p < 50.001) and more often had involvement of 53 lymph node areas (LNA) (80% vs 55%; p < 50.001). Histology in IDH was more likely to be mixed cellularity (46.5% vs 23.6%, p < 50.001) or lymphocyte predominant (20 vs 10%, p = 0.003) and less likely nodular sclerosis (25% vs 63%, p < 50.001). In early-stage unfavorable disease, IDH was associated with a higher treatment failure rate (unadjusted hazard ratio 2, 95% CI, 1.3-3.4; p = 0.003). After controlling for age, sex, stage, histology, B-symptoms and involvement of 53 LNA, the adjusted hazard ratio was 1.25 (95% CI, 0.65-2.4; p = 0.51) so that IDH was no longer associated with a statistically significant treatment failure rate. Poorer outcomes with IDH as compared to SDH are attributable to its association with known adverse prognostic risk factors, but IDH, in itself, is not an independent adverse prognostic factor for treatment failure or survival.