Division of Hematology & Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Oncologist. 2019 Nov;24(11):1488-1495. doi: 10.1634/theoncologist.2019-0172. Epub 2019 Aug 29.
Advanced-stage Hodgkin lymphoma (HL) is a curable malignancy, although outcomes remain poor in certain patients. It remains unclear if recent advances have improved their population-level survival over time.
Using the Surveillance, Epidemiology, and End Results database, we identified patients aged ≥18 years with stage III or IV classical HL as the first primary malignancy, diagnosed between 2000 and 2014 and treated with chemotherapy. Patients were stratified by date of diagnosis into three groups (2000-2004, 2005-2009, 2010-2014) to assess the trends in overall survival (OS).
A total of 9,042 patients with a median age of 41 years were included. The use of frontline radiation therapy decreased in each period (21.3% [2000-2004] vs. 15.5% [2005-2009] vs. 10.7% [2010-2014]; < .001). Three-year OS was significantly higher for patients diagnosed between 2010 and 2014 (81.8%) and 2005 and 2009 (80.6%) compared with 2000 and 2004 (78.5%; = .0008 and .02, respectively). Whereas outcomes were poorest in the age >60 cohort, similar improvements were also seen in 3-year OS over the three time periods within this patient population. On multivariate analysis, diagnosis in the earlier period and minority race were associated with higher mortality. Females and married patients had significantly lower mortality risk.
Survival of patients with advanced-stage HL has continued to improve over time, suggesting the impact of evolving treatment approaches. Three-year OS in the contemporary period remains inadequate at 81.8%, highlighting the need for continued research to improve their outcomes.
This article evaluates contemporary outcomes for advanced-stage Hodgkin lymphoma (HL) in the U.S. using the Surveillance, Epidemiology, and End Results database. Although overall survival (OS) has improved in each 5-year period since 2000, the 3-year OS from 2010 to 2014 remains inadequate at 81.8% and is limited by patient demographics. New therapies are indicated to improve clinical outcomes in advanced-stage HL.
晚期霍奇金淋巴瘤（HL）是一种可治愈的恶性肿瘤，但某些患者的预后仍然较差。目前尚不清楚近年来的进展是否提高了其人群水平的生存率。
我们使用监测、流行病学和最终结果（SEER）数据库，确定了年龄≥18 岁、诊断为 III 期或 IV 期经典 HL 且为首发恶性肿瘤的患者，诊断时间为 2000 年至 2014 年，并接受化疗治疗。根据诊断日期将患者分为三组（2000-2004 年、2005-2009 年、2010-2014 年），以评估总生存率（OS）的趋势。
共纳入 9042 例中位年龄为 41 岁的患者。一线放疗的使用率在每个时期均下降（21.3%[2000-2004 年]、15.5%[2005-2009 年]、10.7%[2010-2014 年]；<.001）。2010-2014 年（81.8%）和 2005-2009 年（80.6%）诊断的患者 3 年 OS 明显高于 2000-2004 年（78.5%；=.0008 和.02）。尽管年龄>60 岁的患者预后最差，但在该患者人群中，3 年 OS 也在三个时间段内呈相似改善。多变量分析显示，早期诊断和少数民族种族与更高的死亡率相关。女性和已婚患者的死亡风险显著降低。
随着时间的推移，晚期 HL 患者的生存状况持续改善，表明治疗方法的不断发展发挥了作用。当代晚期 HL 患者的 3 年 OS 仍不理想（81.8%），这突出表明需要进一步研究以改善其预后。
本研究利用 SEER 数据库评估了美国当代晚期 HL 患者的预后。虽然自 2000 年以来，每个 5 年期间的总生存率（OS）均有所提高，但 2010-2014 年的 3 年 OS 仍不理想（81.8%），并受患者人口统计学特征的限制。需要新的疗法来改善晚期 HL 的临床转归。
