Department of Hematology, Amsterdam UMC, University of Amsterdam, LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Leukemia. 2021 Feb;35(2):494-505. doi: 10.1038/s41375-020-0875-0. Epub 2020 May 28.
Population-based studies of classical Hodgkin lymphoma (cHL) in contemporary clinical practice are scarce. The aim of this nationwide population-based study is to assess trends in primary therapy and relative survival (RS) during 1989-2017. We included 9,985 patients with cHL. Radiotherapy alone was virtually not applied as from 2000 among patients aged 18-69 years with stage I/II disease, following the broader application of chemotherapy combined with radiotherapy. Chemotherapy only was the preferred treatment for patients with stage III/IV disease. Throughout the entire study period, around 20% of patients aged ≥70 years across all disease stages received no anti-neoplastic therapy. The most considerable improvements in 5-year RS were confined to patients aged 18-59 years. Five-year RS for patients with stage I/II disease diagnosed during 2010-2017 was 99%, 98%, 100%, 93%, 84%, and 61% for patients aged 18-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years, respectively. The corresponding estimates for stage III/IV disease were 96%, 92%, 90%, 80%, 58%, and 46%. Collectively, the improvements in survival likely relate to advances in cHL management. These achievements, however, do not seem to translate into significant benefits for patients ≥60 years. Therefore, novel therapies are urgently needed to reduce excess mortality in elderly cHL patients.
基于人群的经典霍奇金淋巴瘤（cHL）的当代临床研究较为少见。本项全国性基于人群的研究旨在评估 1989-2017 年期间，原发性治疗和相对生存率（RS）的趋势。我们纳入了 9985 例 cHL 患者。自 2000 年以来，对于 18-69 岁的 I/II 期患者，几乎不再单独使用放疗，因为化疗联合放疗的应用更为广泛。对于 III/IV 期患者，单独化疗是首选的治疗方法。在整个研究期间，约有 20%的≥70 岁的患者在所有疾病阶段均未接受抗肿瘤治疗。RS 5 年改善最显著的局限于 18-59 岁的患者。在 2010-2017 年诊断的 I/II 期患者中，18-29 岁、30-39 岁、40-49 岁、50-59 岁、60-69 岁和≥70 岁的患者的 5 年 RS 分别为 99%、98%、100%、93%、84%和 61%；对于 III/IV 期患者，相应的估计值分别为 96%、92%、90%、80%、58%和 46%。总的来说，生存率的提高可能与 cHL 管理的进步有关。然而，这些成就似乎并未转化为≥60 岁患者的显著获益。因此，迫切需要新的治疗方法来降低老年 cHL 患者的死亡率。
