霍奇金淋巴瘤的预后因素及其对化疗反应和生存的影响。

Prognostic factors of Hodgkin's lymphoma and their impact on response to chemotherapy and survival.

作者信息

Abdel Hamid Thoraya M, El Zawahry Heba M, Khattab Nabil A, Mowafy Tawheed M, Awaad Mahmoud M, Ali El-Din Nelly H, Mokhtar Nadia M

机构信息

Department of Medical Oncology, NCI-Cairo, Cairo.

出版信息

J Egypt Natl Canc Inst. 2005 Mar;17(1):9-14.

PMID:16353077

Abstract

OBJECTIVE

The aim of this study was to compare the standard prognostic factors of Hodgkin's lymphoma (HL) in relation to response to first line chemotherapy, disease free survival (DFS) and overall survival (OS).

PATIENTS AND METHODS

The study was performed on a group of 100 adult patients diagnosed as HL and who were treated and followed-up in the years 1999 to 2001, in the Medical Oncology Department at National Cancer Institute (NCI), Cairo. The first line chemotherapy was COPP in 40%, ABVD in 35% and COPP/ABV hybrid in 25%. Patients were classified into early stage disease: Stages I, IIA and IIB without poor risk factors, n=43 and advanced stage disease: Stages III, IV and IIB with poor risk factors, n=57 analysis of the prognostic factors for early versus advanced-stage disease was done by univariate and multivariate regression analysis.

RESULTS

Complete remission (CR) was attained in 69% of the patients after first line chemotherapy; being 87.8 % and 54.7% for early and advanced disease, respectively, (p=0.0001). The CR rates after different chemotherapy regimens were 81.8%, 90% and 90% for the ABVD, COPP and COPP/ABV hybrid regimens in the early-disease group; respectively; in contrast to the corresponding figures of 54.5%, 50% and 61.5% in the advanced- stage group. The DFS at 4 years, was 94 %, 55% and 54.5% for the patients treated with ABVD, COPP and COPP/ABV hybrid, respectively (p=0.2). The DFS and OS in this series of patients were 61.3% and 53.7%, being 69.8% and 70.7% for the early and 45.1% and 38.9% for the advanced-disease, respectively The OS of the whole group was significantly related to age (p=0.04), sex (p=0.005), early versus advanced disease (p=0.0001) and B symptoms (p=0.0006).

CONCLUSIONS

The adequate response and DFS of the early compared to the advanced-stage disease supported the evolving role of risk adapted chemotherapy for HL. The prognostic factors proved to be of significant impact in our series. The results of this study pointed to the need for an improved treatment strategy in this potentially curable disease,especially for the advanced disease.

摘要

目的

本研究旨在比较霍奇金淋巴瘤（HL）的标准预后因素与一线化疗反应、无病生存期（DFS）和总生存期（OS）的关系。

患者与方法

本研究对1999年至2001年期间在开罗国家癌症研究所（NCI）医学肿瘤学部门诊断为HL并接受治疗和随访的100名成年患者进行。一线化疗中，40%采用COPP方案，35%采用ABVD方案，25%采用COPP/ABV混合方案。患者分为早期疾病：Ⅰ期、ⅡA期和ⅡB期且无不良风险因素，共43例；晚期疾病：Ⅲ期、Ⅳ期和有不良风险因素的ⅡB期，共57例。通过单因素和多因素回归分析对早期与晚期疾病的预后因素进行分析。

结果

一线化疗后69%的患者达到完全缓解（CR）；早期疾病和晚期疾病的CR率分别为87.8%和54.7%，（p = 0.0001）。早期疾病组中，ABVD、COPP和COPP/ABV混合方案的CR率分别为81.8%、90%和90%；相比之下，晚期疾病组的相应数字分别为54.5%、50%和61.5%。接受ABVD、COPP和COPP/ABV混合方案治疗的患者4年DFS分别为94%、55%和54.5%（p = 0.2）。本系列患者的DFS和OS分别为61.3%和53.7%，早期疾病患者分别为69.8%和70.7%，晚期疾病患者分别为45.1%和38.9%。全组的OS与年龄（p = 0.04）、性别（p = 0.005）、早期与晚期疾病（p = 0.0001）及B症状（p = 0.0006）显著相关。