Stephanie Sasse, Helen Goergen, Annette Plütschow, Boris Böll, Dennis A. Eichenauer, Michael Fuchs, Karolin Behringer, Christian Baues, Andreas Engert, Peter Borchmann, and Bastian von Tresckow, University Hospital of Cologne, Cologne; Max S. Topp, University Hospital of Würzburg, Würzburg; Julia Meissner, University of Heidelberg, Heidelberg; Andreas Neubauer, Philipps University, Marburg, Germany; Joseé M. Zijlstra, VU University Medical Center, Amsterdam, the Netherlands; Richard Greil, Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute and Arbeitsgemeinschaft Medikamentöse Tumortherapie, Salzburg, Austria; and Jana Markova, Charles University in Prague and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic.
J Clin Oncol. 2018 Sep 1;36(25):2603-2611. doi: 10.1200/JCO.2018.78.7192. Epub 2018 Jul 10.
Purpose The prognostic effect of isolated infradiaphragmatic involvement in Hodgkin lymphoma (HL) is controversial, and there are little data about patients treated with current therapies. Therefore, we performed a risk factor analysis to focus on isolated nodal infradiaphragmatic disease in patients treated within the German Hodgkin Study Group trials HD13 (clinical trial information: ISRCTN63474366) and HD14 (clinical trial information: ISRCTN04761296) for early-stage HL. Patients and Methods Characteristics and outcomes of patients who had infradiaphragmatic HL were compared with patients who had supradiaphragmatic disease. Progression-free survival (PFS) and overall survival (OS) were estimated according to Kaplan-Meier methods and were compared between groups using the log-rank test and Cox proportional hazards regression, which was also applied for multivariable analyses that adjusted for relevant baseline characteristics. Results Of 2,903 qualified patients, 223 (7.7%) were diagnosed with isolated nodal infradiaphragmatic disease. In general, these patients were older, had a poorer performance status, were more often male, and had the nodular sclerosis subtype less often than those with supradiaphragmatic disease. After a median follow-up time of 51 months, PFS and OS were significantly worse in patients with infradiaphragmatic disease (5-year PFS and OS, 80.1% and 91.5% v 91.2% and 97.6% in patients with supradiaphragmatic disease; each P < .001). In multivariable analyses, infradiaphragmatic HL remained a significant risk factor in terms of PFS (hazard ratio [HR], 1.5; 95% CI, 1.04 to 2.2; P = .03) and OS (HR, 2.0; 95% CI, 1.2 to 3.5; P = .01). However, inferior PFS and OS could not be observed among those patients treated with the more intensive chemotherapy (two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine [ABVD] in HD13, and two cycles of escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone [BEACOPP] plus two cycles of ABVD in HD14; all patients received 30 Gy of involved-field radiotherapy). Conclusion Early-stage HL that presents with infradiaphragmatic disease only represents a distinct patient group with an inferior outcome. However, this adverse outcome can be outweighed by appropriate combined modality treatment.
目的 在霍奇金淋巴瘤（HL）中，膈下孤立受累的预后影响存在争议，而且关于接受当前治疗的患者的数据很少。因此，我们进行了一项风险因素分析，重点关注在德国 Hodgkin 研究组试验 HD13（临床试验信息：ISRCTN63474366）和 HD14（临床试验信息：ISRCTN04761296）中接受治疗的早期 HL 患者的膈下孤立性结内疾病。将膈下 HL 患者的特征和结局与膈上疾病患者进行比较。无进展生存期（PFS）和总生存期（OS）根据 Kaplan-Meier 方法进行估计，并使用对数秩检验和 Cox 比例风险回归比较组间差异，同时还应用多变量分析调整相关基线特征。
结果 在 2903 名合格患者中，223 名（7.7%）被诊断为膈下结内孤立性疾病。一般来说，这些患者年龄较大，表现状态较差，男性较多，结节性硬化型较少。中位随访时间为 51 个月后，膈下疾病患者的 PFS 和 OS 明显较差（5 年 PFS 和 OS，膈下疾病患者为 80.1%和 91.5%，膈上疾病患者为 91.2%和 97.6%；均 P<0.001）。在多变量分析中，膈下 HL 仍然是 PFS（风险比[HR]，1.5；95%置信区间，1.04 至 2.2；P=0.03）和 OS（HR，2.0；95%置信区间，1.2 至 3.5；P=0.01）方面的显著危险因素。然而，在接受更强化化疗（HD13 中每 2 周期阿霉素、博来霉素、长春新碱和达卡巴嗪[ABVD]，HD14 中每 2 周期博来霉素、依托泊苷、阿霉素、环磷酰胺、长春新碱、丙卡巴肼和泼尼松[BEACOPP]加 2 周期 ABVD]）的患者中，并未观察到较差的 PFS 和 OS。
结论 仅表现为膈下疾病的早期 HL 代表一个具有不良结局的独特患者群体。然而，通过适当的联合治疗模式可以克服这种不良预后。
