Shankar A G, Ashley S, Radford M, Barrett A, Wright D, Pinkerton C R
Paediatric Department, Royal Marsden Hospital, Sutton, Surrey, United Kingdom.
J Clin Oncol. 1997 Jul;15(7):2622-30. doi: 10.1200/JCO.1997.15.7.2622.
Histology has been identified as an important prognostic factor in Hodgkin's disease (HD) in adults. Information regarding the impact of histology on outcome in childhood HD is scarce. This study determines the effect of histology on the overall survival (OS) or progression-free survival (PFS) in a national series of children treated in a standardized manner.
The results of treatment of 331 assessable patients, treated between January 1, 1982 and June 30, 1992, in the United Kingdom Children's Cancer Study Group (UKCCSG) Hodgkin's study I were reviewed to evaluate OS, PFS, and deaths according to stage and histology. Treatment was either involved-field radiation alone (stage IA) or chlorambucil, vinblastine, procarbazine, and prednisolone (ChlVPP) chemotherapy with or without mediastinal radiation. All were clinically staged at diagnosis.
Nodular sclerosing (NS) HD was the most common histologic subtype (155 of 331 patients [47%]) and was uniformly distributed through all stages. Lymphocyte-depletion (LD) HD was extremely uncommon (< 1%). Mixed-cellularity (MC) HD had the highest relapse rate, but this was only significant (P < .05) in stage I patients who received local irradiation alone. There was no other statistically significant difference in OS and PFS between the various histologic subtypes. Multivariate analysis for PFS and OS confirmed that stage was the most important prognostic factor and that histology did not have an effect after stratification by stage.
This study demonstrates that with effective multiagent chemotherapy, histologic subtype does not influence outcome. The high relapse rates in stage I MC subtype indicates that MC HD is biologically aggressive and systemic treatment with or without local irradiation may be indicated. The high relapse rate in stage IV patients appeared to be independent of histology.
组织学已被确认为成人霍奇金淋巴瘤（HD）的一个重要预后因素。关于组织学对儿童HD预后影响的信息较少。本研究确定在以标准化方式治疗的全国儿童系列中，组织学对总生存期（OS）或无进展生存期（PFS）的影响。
回顾了1982年1月1日至1992年6月30日在英国儿童癌症研究组（UKCCSG）霍奇金研究I中接受治疗的331例可评估患者的治疗结果，以根据分期和组织学评估OS、PFS及死亡情况。治疗方法为单纯受累野放疗（IA期）或苯丁酸氮芥、长春碱、丙卡巴肼和泼尼松龙（ChlVPP）化疗，伴或不伴纵隔放疗。所有患者诊断时均进行了临床分期。
结节硬化型（NS）HD是最常见的组织学亚型（331例患者中的155例[47%]），且在所有分期中分布均匀。淋巴细胞消减型（LD）HD极为罕见（<1%）。混合细胞型（MC）HD的复发率最高，但仅在单纯接受局部照射的I期患者中具有统计学意义（P<0.05）。不同组织学亚型之间在OS和PFS方面无其他统计学显著差异。PFS和OS的多因素分析证实分期是最重要的预后因素，且在按分期分层后组织学无影响。
本研究表明，采用有效的多药化疗时，组织学亚型不影响预后。I期MC亚型的高复发率表明MC HD具有生物学侵袭性，可能需要进行有或无局部照射的全身治疗。IV期患者的高复发率似乎与组织学无关。
