Bonadonna G, Valagussa P, Santoro A
Cancer Surv. 1985;4(2):439-58.
The medical records of 396 consecutive patients with a histological diagnosis of Hodgkin's disease were reviewed to assess the prognostic importance of bulky and non-bulky lymphomas. The presence of large lymphadenopathy failed to affect significantly the seven-year results in terms of complete remission (bulky 81.1% v. non-bulky 86.2%), freedom from progression (60.7% v. 65.6%), relapse-free survival (75.1% v. 76.5%) and overall survival (62.7% v. 68.9%). It is noteworthy that in all subsets, ABVD (Adriamycin + bleomycin + vinblastine + dacarbazine), either combined with irradiation or alternated with MOPP (mechlorethamine + vincristine + procarbazine + prednisone), yielded superior results compared with MOPP with or without irradiation. Given the prognostic importance of various bulky sites, the presence of large lymphadenopathy in anatomic regions other than the mediastinum failed to affect results adversely. On the contrary, in patients in stages IIB-IIIA-IIIB, treated with combined modality, the presence of bulky mediastinal involvement did influence prognosis compared with patients with positive but non-bulky mediastinum. At seven years the results were 60.2% v. 79.9% for freedom from progression, 73.2% v. 89.9% for relapse-free survival and 64.8% v. 87.1% for total survival, respectively (P less than 0.03). By contrast, in patients with stage IV disease the extent of mediastinal involvement did not affect results. Nonetheless, the frequency of intrathoracic relapses was higher (26.7%) in patients given chemotherapy alone compared with patients treated with combined modality (11.5%).
回顾了396例经组织学诊断为霍奇金病的连续患者的病历，以评估大包块和非大包块淋巴瘤的预后重要性。大淋巴结病的存在对七年结果在完全缓解（大包块组81.1%对非大包块组86.2%）、无进展生存（60.7%对65.6%）、无复发生存（75.1%对76.5%）和总生存（62.7%对68.9%）方面均未产生显著影响。值得注意的是，在所有亚组中，阿霉素+博来霉素+长春花碱+达卡巴嗪（ABVD），无论是联合放疗还是与氮芥+长春新碱+丙卡巴肼+泼尼松（MOPP）交替使用，与单纯使用MOPP或联合放疗相比，都产生了更好的结果。鉴于不同大包块部位的预后重要性，纵隔以外解剖区域存在大淋巴结病并未对结果产生不利影响。相反，在接受综合治疗的IIB-IIIA-IIIB期患者中，与纵隔阳性但非大包块的患者相比，纵隔大包块受累确实影响预后。七年时，无进展生存分别为60.2%对79.9%，无复发生存分别为73.2%对89.9%，总生存分别为64.8%对87.1%（P小于0.03）。相比之下，在IV期疾病患者中，纵隔受累程度并未影响结果。尽管如此，单纯接受化疗的患者胸腔内复发频率较高（26.7%），而接受综合治疗的患者为11.5%。
