Hasenclever D, Diehl V
Institute of Medical Informatics, Statistics and Epidemiology, University of Leipzig, Germany.
N Engl J Med. 1998 Nov 19;339(21):1506-14. doi: 10.1056/NEJM199811193392104.
Two thirds of patients with advanced Hodgkin's disease are cured with current approaches to treatment. Prediction of the outcome is important to avoid overtreating some patients and to identify others in whom standard treatment is likely to fail.
Data were collected from 25 centers and study groups on a total of 5141 patients treated with combination chemotherapy for advanced Hodgkin's disease, with or without radiotherapy. The data included the outcome and 19 demographic and clinical characteristics at diagnosis. The end point was freedom from progression of disease. Complete data were available for 1618 patients; the final Cox model was fitted to these data. Data from an additional 2643 patients were used for partial validation.
The prognostic score was defined as the number of adverse prognostic factors present at diagnosis. Seven factors had similar independent prognostic effects: a serum albumin level of less than 4 g per deciliter, a hemoglobin level of less than 10.5 g per deciliter, male sex, an age of 45 years or older, stage IV disease (according to the Ann Arbor classification), leukocytosis (a white-cell count of at least 15,000 per cubic millimeter), and lymphocytopenia (a lymphocyte count of less than 600 per cubic millimeter, a count that was less than 8 percent of the white-cell count, or both). The score predicted the rate of freedom from progression of disease as follows: 0, or no factors (7 percent of the patients), 84 percent; 1 (22 percent of the patients), 77 percent; 2 (29 percent of the patients), 67 percent; 3 (23 percent of the patients), 60 percent; 4 (12 percent of the patients), 51 percent; and 5 or higher (7 percent of the patients), 42 percent.
The prognostic score we developed may be useful in designing clinical trials for the treatment of advanced Hodgkin's disease and in making individual therapeutic decisions, but a distinct group of patients at very high risk could not be identified on the basis of routinely documented demographic and clinical characteristics.
采用目前的治疗方法，三分之二的晚期霍奇金淋巴瘤患者可被治愈。预测治疗结果对于避免过度治疗部分患者以及识别那些标准治疗可能失败的患者很重要。
从25个中心和研究组收集了总共5141例接受联合化疗（无论是否联合放疗）治疗晚期霍奇金淋巴瘤患者的数据。数据包括诊断时的治疗结果以及19项人口统计学和临床特征。终点为无疾病进展。1618例患者有完整数据；最终的Cox模型基于这些数据构建。另外2643例患者的数据用于部分验证。
预后评分定义为诊断时存在的不良预后因素数量。七个因素具有相似的独立预后作用：血清白蛋白水平低于4g/dL、血红蛋白水平低于10.5g/dL、男性、年龄45岁及以上、IV期疾病（根据Ann Arbor分期）、白细胞增多（白细胞计数至少15000/立方毫米）和淋巴细胞减少（淋巴细胞计数低于600/立方毫米，或低于白细胞计数的8%，或两者皆有其一）。该评分对无疾病进展率的预测如下：0个因素（占患者的7%），84%；1个因素（占患者的22%），77%；2个因素（占患者的29%），67%；3个因素（占患者的23%），60%；4个因素（占患者的12%），51%；5个或更多因素（占患者的7%），42%。
我们制定的预后评分可能有助于设计晚期霍奇金淋巴瘤的治疗临床试验以及做出个体化治疗决策，但根据常规记录的人口统计学和临床特征无法识别出一组风险极高的特定患者群体。
