Mauch P, Larson D, Osteen R, Silver B, Yeap B, Canellos G, Weinstein H, Rosenthal D, Pinkus G, Jochelson M
Joint Center for Radiation Therapy, Brigham and Women's Hospital, Boston, MA 02115.
J Clin Oncol. 1990 Feb;8(2):257-65. doi: 10.1200/JCO.1990.8.2.257.
Staging laparotomy was performed as part of the routine recommended diagnostic evaluation following clinical staging (CS) in 692 patients presenting with supradiaphragmatic Hodgkin's disease (HD). Various clinical factors were analyzed by multivariate analysis for prediction of abdominal involvement. Factors that were statistically significant for predicting disease below the diaphragm included CS III-IV disease (P less than .001), B symptoms (P less than .001), mixed cellularity (MC) or lymphocytic depletion (LD) histology (P = .017), number of supradiaphragmatic sites greater than or equal to 2 (P = .001), male sex (P = 0.034) and age greater than or equal to 40 years (P = .004). Separate analyses were performed for various subgroups of CS IA-IIA, CS IB-IIB, CS IIIA-IVA, and CS IIIB-IVB patients. Upstaging was seen in 0% to 55% of CS I-II patients based on subgroup. Male sex, B symptoms, and number of sites above the diaphragm greater than or equal to 2 all independently predicted for positive surgical staging in CS I-II patients. Sixty-four percent of CS I-II patients who were upstaged had extensive abdominal disease by positive lower abdominal nodes or multiple splenic nodules (greater than or equal to 5). Downstaging (to pathological stage [PS] I-II) was seen in 9% to 68% of patients with CS III-IV disease based on subgrouping. Age greater than or equal to 40, MC or LD histology, and B symptoms all independently predicted for positive surgical staging in CS III-IV patients. Downstaging was more frequently seen in CS IIIA-IVA patients (55%) than in patients who were CS III-IVB (22%). Four subgroups of patients who had a low probability (less than 10%) of stage or treatment change following laparotomy were identified. These included CS IA female patients, CS IA male patients with lymphocyte predominance histology or high neck presentations, and patients with CS IIIB-IVB disease and account for 21% of the study population. Staging laparotomy altered the stage and treatment of a significant number of the remaining 79% patients and should continue to be recommended for this group of patients.
对692例膈上霍奇金淋巴瘤（HD）患者进行了分期剖腹探查术，作为临床分期（CS）后常规推荐诊断评估的一部分。通过多因素分析对各种临床因素进行分析，以预测腹部受累情况。对膈下疾病预测具有统计学意义的因素包括CS III-IV期疾病（P<0.001）、B症状（P<0.001）、混合细胞型（MC）或淋巴细胞消减型（LD）组织学类型（P=0.017）、膈上病灶数≥2个（P=0.001）、男性（P=0.034）以及年龄≥40岁（P=0.004）。对CS IA-IIA、CS IB-IIB、CS IIIA-IVA和CS IIIB-IVB患者的各个亚组分别进行了分析。根据亚组情况，CS I-II期患者中分期上调的比例为0%至55%。男性、B症状以及膈上病灶数≥2个均独立预测CS I-II期患者手术分期为阳性。分期上调的CS I-II期患者中，64%因下腹部淋巴结阳性或多个脾结节（≥5个）而存在广泛腹部疾病。根据亚组情况，CS III-IV期患者中分期下调（至病理分期[PS] I-II）的比例为9%至68%。年龄≥40岁、MC或LD组织学类型以及B症状均独立预测CS III-IV期患者手术分期为阳性。CS IIIA-IVA期患者（55%）分期下调的情况比CS III-IVB期患者（22%）更常见。确定了四个剖腹探查术后分期或治疗改变可能性低（<10%）的患者亚组。这些亚组包括CS IA期女性患者、具有淋巴细胞为主型组织学类型或高颈部病变的CS IA期男性患者，以及CS IIIB-IVB期患者，占研究人群的21%。分期剖腹探查术改变了其余79%患者的分期和治疗，对于这组患者仍应继续推荐采用该方法。
