Prognostic Factors in Hodgkin’s Disease: Multivariate Analysis of 327 Patients from a Single Institution
2000
On the basis of a
retrospective study of 327 patients with Hodgkin’s disease (HD), the
prognostic significance of several factors, accepted previously and
recently proposed, has been analyzed with regard to response to
treatment and the survival time. Multivariate regression analysis
strongly decreased the number of potentially prognostic parameters. The
only independent, pretreatment factors negatively influenced by either
time of survival or response to treatment were the following: age at
diagnosis of more than 45 years, advanced (IIIB/IV) clinical stage,
poor clinical status according to Karnofsky’s scale (score less than
70), presence of systemic symptoms, mixed cellularity/lymphocyte
depletion histological type, multisite peripheral nodal
localization of the disease, abdominal lymphadenopathy, and large
primary tumor mass (bulky disease). Short time to achieve complete
remission (during the first four courses of chemotherapy) has
proven to be significantly positive predictive factor. Cumulative dose
of cytostatics lower than programmed was a significantly negative
prognostic factor that correlated with a shorter time of survival. Lack
of or a too-low dose of radiotherapy had the same predictive value.
High activity of serum lactate dehydrogenase correlated moderately with
poor response to the first-line treatment but did not influence the
survival time. Other clinical, morphological, and biochemical
parameters influenced neither the prognosis nor the response to
treatment. Additionally, immunohistochemical examinations for
proliferating cell nuclear antigen and the protein products of
the p53 and bcl-2 genes were
performed on the lymph nodes obtained from the patients with HD. High
expression of proliferating cell nuclear antigen, p53, and BCL-2
correlated with poor response to the treatment and/or short time of
survival. Statistical analysis has led us to the conclusion that the
pretreatment expression of these oncoproteins can be taken into
consideration as a new prognostic factor in HD.
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