Survival of the older patient compared with the younger patient with hodgkin's disease. Influence of histologic type, staging, and treatment

The clinical features and course of Hodgkin's disease (HD) were investigated in 160 previously tonsillectomized patients and compared with 375 nontonsillectomized ones. In both groups, sex, social class, histologic type, stage and symptoms were almost identically distributed. Tonsillectomized patients showed a higher incidence of initial cervical forms (p < 0.05) and more frequently developed the disease under 35 years of age (p < 0.001), thus also reflecting the different policies of the otolaryngologists in the past few decades. Moreover, the tonsillectomized patients enjoyed a significantly better survival (p ≈ 0.01) than the nontonsillectomized ones. Adjusted survival curves for age and site of initial involvement proved that the favorable prognostic value of tonsillectomy was not due to the altered distribution of these 2 factors in the 2 groups; in addition, an earlier diagnosis in tonsillectomized patients could be excluded. The favorable effect of tonsillectomy in HD patients might be related specifically to the reduced portion of immunologically reacting oropharyngeal lymphoid tissue remaining after tonsillectomy. A decreased output of the specific immune-complexes, which are responsible for the disease, according to Vianna's theory, might be hypothesized in tonsillectomized patients.

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Mortality in Relation to Histologic Type in Hodgkin’s Disease

Blood ◽

10.1182/blood.v11.3.211.211 ◽

1956 ◽

Vol 11 (3) ◽

pp. 211-224 ◽

Cited By ~ 65

Author(s):

HANS F. SMETANA ◽

BERNARD M. COHEN

Keyword(s):

Cause Of Death ◽

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Correct Diagnosis ◽

Malignant Neoplasm ◽

Entire Group ◽

Histologic Type ◽

Histologic Diagnosis ◽

Biopsy Material ◽

The Difference

Abstract 1. A study of the trends of mortality in Hodgkin’s disease of diverse histologic type was undertaken with 437 cases at the AFIP Lymphatic Tumor Registry. These represent the records and pathologic material in the Registry of all white males in whom the disease was diagnosed during service in the Army in the World War II period (1941-1946). 2. Follow-up through June 30, 1953 by means of service, Veterans Administration and other records was carried out by established methods which have been demonstrated to result in virtually complete tracing. 3. On histologic analysis of the cases, 388 were confirmed as Hodgkin’s disease and these were differentiated by histologic type as Hodgkin’s granuloma (308 cases, 79 pet cent), Hodgkin’s paragranuloma (35 cases, 9 per cent) and an unspecified group (40 cases, 10 per cent) in which a decision as to type could not be made and as sarcoma (5 cases, 1 per cent). A further analysis of the 308 cases of Hodgkin’s granuloma showed secondary histologic characteristics of sclerosis in 57 instances (18.5 per cent), and of sarcoid in 13 cases (4.2 per cent). 4. The mortality at seven years after diagnosis was 77.1 per cent for the entire group of cases of confirmed Hodgkin’s disease; 28.6 per cent for Hodgkin’s paragranuloma; and 82.8 per cent for Hodgkin’s granuloma. The difference in mortality between these types is significant. 5. The seven year mortality rate for granuloma without qualifying histologic characteristics was 85.7 per cent; for cases with a sarcoid component, 81.8 per cent. The difference in mortality between nonsclerosing and sclerosing Hodgkin’s granuloma (87.5 per cent as against 74.5 per cent) was significant although the significance is borderline. 6. On re-evaluation of the 15 instances diagnosed as Hodgkin’s paragranuloma and terminating fatally, it appeared from the original biopsy material that the diagnosis probably should have been Hodgkin’s granuloma in five instances, and "malignant lymphoma, type uncertain (Hodgkin’s disease not ruled out)" in one case. In the remaining nine instances the histologic diagnosis of the original biopsy material of paragranuloma was confirmed. Autopsy material was available in three of the fifteen cases; two of these showed widespread Hodgkin’s granuloma and one presented a generalized malignant neoplasm, possibly of the Hodgkin’s sarcoma type. 7. For 95 per cent of the deaths among the histologically confirmed cases of Hodgkin’s disease the reported cause of death as found in hospital records or on death certificates was Hodgkin’s disease. It is not known for many of these whether the stated cause of death was verified by autopsy. 8. From the available evidence the question of transformation from paragranuloma to granuloma, or to sarcoma, or to any other form of lymphoma cannot be answered. 9. The correct diagnosis of the types of Hodgkin’s disease and the differentiation of secondary histologic characteristics are of importance in the evaluation of the prognosis, and for the choice of treatment.

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Hodgkin's Disease in Children. Pathologic Study of 87 Cases

Tumori Journal ◽

10.1177/030089167906500608 ◽

1979 ◽

Vol 65 (6) ◽

pp. 719-728 ◽

Cited By ~ 4

Author(s):

Antonino Carbone

Keyword(s):

Hodgkin's Disease ◽

Hodgkin’S Disease ◽

Stage Iv ◽

Stage I ◽

Stage Ii ◽

Clinical Staging ◽

Time Interval ◽

Histologic Type ◽

Stated Time ◽

Age Range

From 1963 to 1977 at the Istituto Nazionale Tumori at Milan, 112 patients below the age of 16 years with Hodgkin's disease (HD) were observed, representing 13.2 % of all the cases of this disease seen during the stated time interval. Eighty-seven of these cases are the subject of the present study. Fifty-nine patients were males and 28 females (2.1:1 ratio). The age range varied from 2 years 10 months to 15 years 10 months (median 10 years). Forty-three (49.4%) children, of whom 35 were males and 8 females, were below the age of 10 years at the onset of their disease. The clinical staging resulted in 34 patients as stage I, 33 as stage II, 13 as stage III and 7 as stage IV. The histologic type was nodular sclerosis (NS) in 49 cases (56.3 %), lymphocytic predominance (LP) in 15 cases (17.2 %), mixed cellularity (MC) type in 9 cases (10.3 %) and lymphocytic depletion (LD) in 8 cases (9.2 %). In the remaining 6 cases the histologic classification was not applicable. LP type in 15/15 (100 %) patients was associated with stages I and II, and NS in 38/49 (77 %) patients was related to stage I and stage II. The latter was also the istologic type most often encountered in patients with stage II disease (23/33 or 70 %). Eleven patients have died, and their survival varied from 6 to 47 months (median 30 months). The histologic type was LD in 4 cases, NS in 3 cases, MC in 1 case, and LP in 1 case. In the other 2 nonsurvivors, the histologic type was not identifiable. Of the 23 patients with more than a 5-year survival, 14 (60.8 %) had NS HD. As in adults, LP and NS were associated with early stages of the disease and with long survival.

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Prognostic groups for management of localized Hodgkin's disease.

Journal of Clinical Oncology ◽

10.1200/jco.1985.3.3.393 ◽

1985 ◽

Vol 3 (3) ◽

pp. 393-401 ◽

Cited By ~ 71

Author(s):

S B Sutcliffe ◽

M K Gospodarowicz ◽

D E Bergsagel ◽

R S Bush ◽

R E Alison ◽

...

Keyword(s):

Radiation Therapy ◽

Survival Rate ◽

Relapse Rate ◽

Hodgkin's Disease ◽

Radiation Treatment ◽

Hodgkin’S Disease ◽

Clinical Stage ◽

Histologic Type ◽

Type Group ◽

Free Rate

Two hundred fifty-two patients receiving radical irradiation for clinical stages I and II Hodgkin's disease between 1968 to 1977 had an actuarial ten-year survival rate of 78% and a relapse-free rate of 61%. Sixty-seven patients receiving chemotherapy followed by radiation had a 78% survival rate and a 63% relapse-free rate. Independent prognostic factors for survival and relapse were age, stage, and histology. Disease bulk was predictive only of relapse. Neither site of presentation above or below the diaphragm nor presence of mediastinal involvement was predictive for survival or relapse; however, patients with large mediastinal masses (greater than or equal to 10 cm absolute diameter) had a significantly higher intrathoracic failure rate with conventional mantle irradiation. Analysis of failure, according to age, clinical stage, and histologic type, showed three groups of patients defined according to the risk of relapse with radiation therapy: those with isolated upper cervical stage IA disease (group 1, relapse rate 8%), younger patients with localized stages I and II disease of favorable histologic type (group 2, relapse rate 35%), and older patients with extensive or symptomatic stages I and II disease of less favorable histologic type (group 3, relapse rate 70%). Subsequent analysis of radiation treatment volume indicates that the use of upper abdominal irradiation for patients in group No. 2 could yield results equivalent to those achieved with radiation therapy for surgically staged patients.

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