Provencio Mariano, Millán Isabel, España Pilar, Sánchez Antonio C, Sánchez José J, Cantos Blanca, Vargas Juan A, Bellas Carmen, García Vanesa, Sabin Pilar, Bonilla Félix
Medical Oncology, University Hospital Puerta de Hierro, Madrid, Spain.
Clin Cancer Res. 2008 Aug 15;14(16):5300-5. doi: 10.1158/1078-0432.CCR-07-0927.
Hodgkin's disease is considered a model of curable illness. However, long-term studies show excessive mortality in relation to the general population. We studied the various causes of death by use of competing risks and their evolution over the years.
All patients diagnosed with Hodgkin's disease at our institution between 1967 and 2003 were included. The competing risks of causes of death and their vital situation were examined in three time periods: cohort A with patients treated before 1980, cohort B with patients treated from 1981 to 1986, and cohort C with patients treated from 1986 onwards.
We studied 534 patients, with a median follow-up time of 9.1 years for the whole cohort. The 5-year, 15-year, and 20-year Kaplan-Meier survival estimates for all patients were 81%, 72%, and 65%, respectively. At the close of the study, 337 (63.1%) were alive and 170 (31.8%) patients had died. The most common cause of death was the progression of Hodgkin's disease, followed by deaths due to a second tumor. Survival was significantly worse in the first period than in the other two (P < 0.001), and in the three periods, the main cause of death was tumor progression.
The progression of Hodgkin's disease is the main cause of death. Over time, a reduction in death related to infection and the acute toxicity of treatment was seen. A lot of patients still die for reasons linked to delayed side effects of radiotherapy, such as second tumors and heart disease, which is important to plan preventive activities and clinical research.
霍奇金淋巴瘤被认为是一种可治愈疾病的典范。然而，长期研究表明，相较于普通人群，其死亡率过高。我们运用竞争风险分析法研究了各种死亡原因及其多年来的演变情况。
纳入了1967年至2003年间在我们机构被诊断为霍奇金淋巴瘤的所有患者。在三个时间段内检查了死亡原因的竞争风险及其生存状况：A组为1980年前接受治疗的患者，B组为1981年至1986年接受治疗的患者，C组为1986年以后接受治疗的患者。
我们研究了534例患者，整个队列的中位随访时间为9.1年。所有患者的5年、15年和20年Kaplan-Meier生存估计分别为81%、72%和65%。在研究结束时，337例（63.1%）患者存活，170例（31.8%）患者死亡。最常见的死亡原因是霍奇金淋巴瘤进展，其次是死于第二种肿瘤。第一期的生存率明显低于其他两期（P<0.001），在这三个时期，主要死亡原因都是肿瘤进展。
霍奇金淋巴瘤进展是主要死亡原因。随着时间推移，与感染和治疗急性毒性相关的死亡有所减少。许多患者仍因放疗延迟副作用相关原因死亡，如第二种肿瘤和心脏病，这对于规划预防措施和临床研究很重要。
