Colonna P, Jais J P, Desablens B, Harousseau J L, Brière J, Boasson M, Lemevel A, Casassus P, Le Prisé P Y, Guilhot F, Ghandour C, Lejeune F, Andrieu J M
Hôpital Laënnec, Paris, France.
J Clin Oncol. 1996 Jun;14(6):1928-35. doi: 10.1200/JCO.1996.14.6.1928.
To identify prognostic factors in 262 patients with supradiaphragmatic Hodgkin's disease (HD), clinical stages (CS) I and II, prospectively treated between 1981 and 1988 according to the Paris-Ouest-France (POF) 81/12 protocol by three 1-month cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine plus methylprednisone (ABVD-MP) followed by subtotal nodal irradiation (RT).
The size of mediastinal tumor (MT) was measured in all patients: 66 did not have MT (NoMT); 105 had a small-size MT (SSMT), ie, mediastinal mass ratio (MMR) less than 0.33; 58 had a medium-size MT (MSMT), ie, MMR > or = 0.33 and less than 0.45; and 33 had a bulky MT (BuMT), ie, MMR > or = 0.45. All patients received three cycles (CS IA, one cycle only) of ABVD-MP; patients in partial remission (PR) or complete remission (CR) after chemotherapy (CT) received supradiaphragmatic RT (involved fields, 40 Gy; adjacent fields, 30 Gy) plus lumboaortic and splenic RT (30 Gy); patients not in CR or PR after CT received salvage CT.
Two hundred seventeen patients (82.8%) entered CR after CT and 258 (98.5%) after RT. Ten-year freedom-from-progression (FFP) and survival rateswere 88.6% and 89.4%, respectively. According to univariate analysis, MT size and post-CT status were the only factors to influence both FFP and survival. For patients with NoMT or SSMT, those with MSMT, and those with BuMT, FFP rates were 94.1%, 87.0%, and 63.0% (P < .001), respectively, while corresponding survival rates were 92.6%, 87.2%, and 78.2% (P < .05). FFP rates were significantly different between the patients who achieved CR and those who did not achieve CR after CT: 94.6% versus 65.3% (P < .001); corresponding survival rates were 89.9% and 73.7% (P < .01). Multivariate analysis confirmed that MT size and post-CT status were the only two prognostic factors for FFP; for survival, the same two characteristics, as well as age (< 40 v > or = 40 years), significantly affected prognosis. We were thus able to identify three groups. The 33 patients (12.6%) with a BuMT had 10-year FFP and survival rates of 63.0% and 78.2%, respectively. Of 229 patients without BuMT, the 195 who attained CR after CT had an optimal prognosis (FFP, 96.6%; survival, 93.6%), while those who failed to achieve CR after CT had an intermediate prognosis (FFP, 68.8%; survival, 77.6%).
These results demonstrate the independent impact on HD prognosis of tumor burden and post-CT status.
识别262例膈上霍奇金淋巴瘤（HD）患者（临床分期[CS]为I期和II期）的预后因素，这些患者于1981年至1988年间根据巴黎 - 法国西部（POF）81/12方案接受前瞻性治疗，采用三个1个月周期的阿霉素、博来霉素、长春花碱和达卡巴嗪加甲基强的松龙（ABVD - MP）治疗，随后进行次全淋巴结照射（RT）。
测量所有患者纵隔肿瘤（MT）的大小：66例无MT（无MT组）；105例有小尺寸MT（SSMT组），即纵隔肿块比率（MMR）小于0.33；58例有中等尺寸MT（MSMT组），即MMR≥0.33且小于0.45；33例有巨大MT（BuMT组），即MMR≥0.45。所有患者接受三个周期（CS IA期仅接受一个周期）的ABVD - MP治疗；化疗（CT）后部分缓解（PR）或完全缓解（CR）的患者接受膈上RT（受累野，40 Gy；相邻野，30 Gy）加腰主动脉和脾脏RT（30 Gy）；CT后未达到CR或PR的患者接受挽救性CT治疗。
217例患者（82.8%）CT后进入CR，258例（98.5%）RT后进入CR。十年无进展（FFP）率和生存率分别为88.6%和89.4%。单因素分析显示，MT大小和CT后状态是影响FFP和生存的唯一因素。无MT或SSMT组、MSMT组和BuMT组患者的FFP率分别为94.1%、87.0%和63.0%（P <.001），相应的生存率分别为92.6%、87.2%和78.2%（P <.05）。CT后达到CR和未达到CR的患者FFP率有显著差异：94.6%对65.3%（P <.001）；相应的生存率分别为89.9%和73.7%（P <.01）。多因素分析证实，MT大小和CT后状态是FFP的仅有的两个预后因素；对于生存，同样的这两个特征以及年龄（<40岁对≥40岁）显著影响预后。因此我们能够识别出三组。33例（12.6%）有BuMT的患者十年FFP率和生存率分别为63.0%和78.2%。在229例无BuMT的患者中，CT后达到CR的195例预后最佳（FFP，96.6%；生存，93.6%），而CT后未达到CR的患者预后中等（FFP，68.8%；生存，77.6%）。
这些结果证明了肿瘤负荷和CT后状态对HD预后的独立影响。
