a Pediatric Oncology Unit, Department of Women's and Children's Health , Uppsala University , Uppsala , Sweden.
b Clinical Epidemiology Unit, Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden.
Acta Oncol. 2018 Feb;57(2):276-282. doi: 10.1080/0284186X.2017.1355563. Epub 2017 Aug 1.
Hodgkin lymphoma (HL) treatment protocols for children, adolescents and young adults traditionally differ, but the biological and clinical justification for this remains uncertain.
We compared age-dependent clinical presentation and treatment and outcome for 1072 classical HL patients 0-24 years diagnosed in Denmark (1990-2010) and Sweden (1992-2009) in pediatric (n = 315, Denmark <15 years, Sweden <18 years) or adult departments (n = 757). Distribution of clinical characteristics was assessed with Pearson's chi-test and Mantel-Haenszel trend test. The Kaplan-Meier method was used for survival analyses. Hazard ratios (HR) were used to compare the different treatment groups and calculated using Cox regression.
Children (0-9 years) less often presented with advanced disease than adolescents (10-17 years) and young adults (18-24 years) (stage IIB-IV: children 32% vs. adolescents 50%, and adults 55%; p < .005). No variation in overall survival (OS) was seen between pediatric and adult departments or by country. Danish pediatric patients received radiotherapy (36%) less frequently than Swedish pediatric patients (71%) (p < .0001). Ten-year event-free survival (EFS) was lower among Danish pediatric patients (0-14 years) (0.79; 95% confidence interval (CI) 0.70-0.86) than among Swedish pediatric patients (0-17 years) (0.88; 95% CI 0.83-0.92), HR (1.93; 95% CI 1.08-3.46). A similar pattern was seen between adult patients in the two countries: Denmark 10-year EFS 0.85 (95% CI 0.81-0.88), Sweden 0.88 (95% CI 0.84-0.91), adjusted HR 1.51 (95% CI 1.03-2.22).
Adolescents and young adults shared similar clinical presentation suggesting a rationale of harmonized treatment for these groups. Both adult and pediatric protocols provided high OS with no significant difference between the departments. The less frequent use of radiotherapy in Danish pediatric patients corresponded to a lower EFS, but comparable OS in all groups confirmed effective rescue strategies for the relapsing patients.
霍奇金淋巴瘤（HL）的儿童、青少年和年轻成人治疗方案传统上有所不同，但这种区分的生物学和临床依据仍不确定。
我们比较了丹麦（1990-2010 年）和瑞典（1992-2009 年） 1072 例经典 HL 患儿（年龄 0-24 岁）和成人（年龄 0-24 岁）患者的年龄依赖性临床表现、治疗和结局。采用 Pearson 卡方检验和 Mantel-Haenszel 趋势检验评估临床特征分布。采用 Kaplan-Meier 法进行生存分析。采用 Cox 回归计算风险比（HR）以比较不同治疗组。
0-9 岁儿童较 10-17 岁青少年和 18-24 岁年轻成人（IIIB-IV 期：儿童 32% vs. 青少年 50%，和成人 55%；p<0.005）更常出现晚期疾病。儿科和成人科室或国家之间的总生存（OS）无差异。丹麦儿科患者接受放疗（36%）较瑞典儿科患者（71%）少（p<0.0001）。丹麦 0-14 岁儿科患者 10 年无事件生存（EFS）（0.79；95%CI 0.70-0.86）较瑞典 0-17 岁儿科患者（0.88；95%CI 0.83-0.92）低，HR（1.93；95%CI 1.08-3.46）。两国成人患者中也存在类似模式：丹麦 10 年 EFS 0.85（95%CI 0.81-0.88），瑞典 0.88（95%CI 0.84-0.91），调整后的 HR 1.51（95%CI 1.03-2.22）。
青少年和年轻成人具有相似的临床表现，提示对这些人群采用协调一致的治疗方案具有合理性。成人和儿科方案均提供了较高的 OS，科室之间无显著差异。丹麦儿科患者放疗应用较少，EFS 较低，但所有患者组 OS 相当，证实了对复发患者的有效挽救策略。
