An Immunohistochemical Score Based On CD68 and FOXP3 Expression In the Tumour Microenvironment at Diagnosis Defines Prognostic Groups In Both Early and Advanced Stage Classical Hodgkin Lymphoma

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 750-750 ◽  
Author(s):  
Paul Greaves ◽  
Andrew James Clear ◽  
David Andrew Owen ◽  
Finlay Macdougall ◽  
Andrew Wilson ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Prognostic Significance ◽  
Automated Image Analysis ◽  
Advanced Stage ◽  
Classical Hodgkin Lymphoma ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Prognostic Groups ◽  
Good Risk

Abstract Abstract 750 The non-malignant immune infiltrate comprises the bulk of pathologic tissue in classical Hodgkin lymphoma (CHL). This microenvironment has the potential to induce both malignant cell suppression and support. Increased macrophage infiltration assessed by CD68 expression has been shown to confer adverse prognostic significance (Steidl et al. N Engl J Med, 2010; 362:875-85) while increased FOXP3 expressing T cells are beneficial in this disease (Tzankov et al. Haematologica, 2008; 93: 193–200). However no histological score routinely leads to modification of treatment. Assessing outcomes by the parameters of overall survival (OS), disease specific survival (DSS) and freedom from first line treatment failure (FFTF) at 5 years in a cohort of patients treated at St Bartholomew's Hospital (Barts), London we developed a prognostic score based upon expression of both FOXP3 and CD68 in the CHL microenvironment which defined poor and good risk groups in both early (Stages I and IIA) and advanced stage disease, including a 'poor risk' early stage group with 25% FFTF and a ‘good risk' advanced stage group with 90% FFTF. Immunohistochemical analysis was performed on tissue microarrays (TMAs) from previously untreated patients' diagnostic lymph node biopsies in whom clinical outcome was available. From all 1056 adult patients with HL diagnosed at Barts between 1972 and 2005, high quality formalin-fixed paraffin-embedded tissue was available for 122 (12%), with characteristics representative of the whole group. Median age of the 122 patients was 30 (range 18–80) years, 35% female, 71% advanced stage with median follow up 16.5 (range 2–40) years. Triplicate cores were made from areas of high cellularity, containing malignant cells and avoiding fibrotic, acellular portions, arrayed onto glass slides and stained immunohistochemically for FOXP3 or CD68. Absolute and proportional numbers of FOXP3+ nuclei and CD68+ cell bodies were counted across all intact cores using an automated image analysis system (Ariol), confirmed by expert histopathologists, and means calculated and corrected to a single high powered field (hpf). Recursive partitioning was used to generate optimal cutoff values discriminating prognostic groups and comparisons performed by the chi-square test. Using cutoffs of <5%, 5–15% and >15% to define low, intermediate and high CD68 density, 3 prognostic groups were defined, the favourable group having the lowest CD68+ density. OS for low, intermediate and high groups were 89%, 80% and 65% respectively (p=0.02), with FFTF 82%, 64% and 29% (p=0.001). Prognostic significance was maintained in subgroups presenting with advanced stage (FFTF 73%, 63% and 33%, p=0.03), as well as early stage disease (FFTF 92%, 70% and 20%, p=0.01). Using cutoffs of <12.5, 12.5–50 and >50 nuclei/hpf to define low, intermediate and high FOXP3+ cell density, 3 prognostic groups were defined, the favourable group having the highest FOXP3+ density. OS for low, intermediate and high groups were 68%, 80% and 94% respectively (p=0.006), with FFTF 50%, 62%, and 84% (p=0.002). Prognostic significance was maintained for both advanced (FFTF: 48%, 60% and 72%, p=0.04) and early stage disease (FFTF: 57%, 67% and 100%, p=0.04). A combined ‘FOXP3/CD68 score' derived from the patient's prognostic group for both markers, for which suitable cores were available on 98 patients, further improved the predictive value of each individually (See Figure). In this model, favourable, intermediate and unfavourable groups had 5 year FFTF of 93%, 62% and 47% (p=0.0002), DSS 93%, 82% and 63% (p=0.03) and OS 93%, 82% and 59% (p=0.002). The score retained prognostic significance for 5 year FFTF and OS in the subgroup of patients presenting with advanced (FFTF: 90%, 59% and 46%, p=0.008; OS: 90%, 80% and 54%, p=0.004) as well as early stage disease (FFTF: 100%, 71% and 25%, p=0.005; OS: 100%, 82% and 75%, trend only, p=ns). We conclude that FOXP3 and CD68 are important independent factors, which in combination have considerable predictive power and will now be validated prospectively. Disclosures: No relevant conflicts of interest to declare.

Evaluation of treatment outcome in 175 patients with Hodgkin lymphoma aged 60 years or over: the SHIELD study

Blood ◽  
2012 ◽  
Vol 119 (25) ◽  
pp. 6005-6015 ◽  
Author(s):  
Stephen J. Proctor ◽  
Jennifer Wilkinson ◽  
Gail Jones ◽  
Gillian C. Watson ◽  
Helen H. Lucraft ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Cox Regression ◽  
Early Stage ◽  
Univariate Analysis ◽  
Central Element ◽  
Disease Stage ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Large Patient ◽  
Stage Disease

Abstract The SHIELD program for Hodgkin lymphoma in patients 60 years of age or older, prospectively evaluated clinical features and outcome in a large patient cohort (n = 175). The central element was a phase 2 study of VEPEMB chemotherapy (n = 103, median age 73 years) incorporating comorbidity assessment. A total of 72 other patients were treated off-study but registered prospectively and treated concurrently with: ABVD (n = 35); CLVPP (n = 19), or other (n = 18). Of VEPEMB patients, 31 had early-stage disease (stage 1A/2A) and received VEPEMB 3 times plus radiotherapy. Median follow-up was 36 months. Complete remission (CR) rate (intention-to-treat) was 74% and 3-year overall survival (OS) and progression-free survival (PFS) were 81% and 74%, respectively. A total of 72 patients had advanced-stage disease (stage 1B/2B/3 or 4) and received VEPEMB 6 times. CR rate was 61% with 3-year OS and PFS of 66% and 58%, respectively. Of patients achieving CR, 13% with early-stage and 5% with advanced-stage disease progressed. Overall treatment-related mortality was 7%. In patients treated with curative intent with VEPEMB, ABVD, and CLVPP (n = 157), CR linked to several factors in univariate analysis. In a Cox regression model only, obtaining CR remained significant for OS and CR plus comorbidity and age for PFS. RS-EBV status had no significant effect on outcome.

scholarly journals HODGKIN LYMPHOMA IN OLDER PATIENTS: AN ORPHAN DISEASE?

2014 ◽  
Vol 6 (1) ◽  
pp. e2014050 ◽  
Author(s):  
Antoine Thyss ◽  
Esma Saada ◽  
Lauris Gastaud ◽  
Frédéric Peyrade ◽  
Daniel Ré
Keyword(s):  
Hodgkin Lymphoma ◽  
Prospective Studies ◽  
Older Patients ◽  
Early Stage ◽  
The Elderly ◽  
Study Group ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Younger Patients ◽  
Stage Disease

Hodgkin Lymphoma HL ica be  cured in the large majority of younger patients, but prognosis for older patients, especially those with advanced-stage disease, has not improved substantially. The percentage of HL patients aged over 60 ranges between 15% and 35%.A minority of them is enrolled into clinical trials. HL in the elderly have some specificities: more frequent male sex, B-symptoms, advanced stage, sub diaphragmatic presentation, higher percentage of mixed cellularity, up to 50% of advanced cases associated to EBV. Very old age (>70) and comorbidities are factor of further worsening prognosis. Like in younger patients, ABVD is the most used protocol, but treatment outcome remains much inferior with more frequent, severe and sometimes specific toxicities. Few prospective studies with specific protocols are available. The main data have been published by the Italian Lymphoma Group with the VEPEMB schedule and the German Hodgkin Study Group with the PVAG regimen. Recently, the Scotland and Newcastle Lymphoma Study Group published the SHIELD program associating a prospective phase 2 trial with VEPEMB and a prospective registration of others patients. Patients over 60y with early-stage disease received three cycles plus radiotherapy and had 81% of 3-year overall survival (OS).Those with advanced-stage disease received six cycles, with 3-year OS of 66%.The role of geriatric and comorbidity assessment in the treatment’s choice for HL in the elderly is a major challenge. The combination of loss of activities of daily living combined with the age stratification more or less 70y has been shown as a simple and effective survival model. Hopes come from promising new agents like brentuximab-vedotin (BV) a novel antibody-drug conjugate. The use of TEP to adapt the combination of chemotherapy and radiotherapy according to the metabolic response could also be way for prospective studies.  

scholarly journals Response-adapted frontline therapy for Hodgkin lymphoma: are we there yet?

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 316-322 ◽  
Author(s):  
Peter W. M. Johnson
Keyword(s):  
Disease Control ◽  
Hodgkin Lymphoma ◽  
Early Stage ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Interim Pet ◽  
Early Results ◽  
Stage Disease ◽  
Consolidation Radiotherapy ◽  
Pet Scans

Abstract Treating Hodgkin lymphoma by using chemotherapy with or without radiotherapy is highly successful, with substantially fewer deaths from lymphoma than from other causes in recent studies of both early-stage and advanced-stage disease. Long-term toxicity is a major consideration in this context, and recent trials have used functional imaging with [18F]fluorodeoxyglucose (FDG) positron emission tomography early in the course of treatment (interim PET) to assess response and modulate subsequent therapy. In early-stage disease, this has allowed omission of consolidation radiotherapy after a good response to doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy, and trials have shown that this can be done without detriment to overall survival, despite a small increase in rates of recurrence of ∼5%. Conversely, escalation to more intensive chemotherapy with bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) for those with positive interim PET scans seems to be an effective strategy with improved disease control. In advanced-stage disease, several groups have elected to start treatment with ABVD and escalate to BEACOPP or myeloablative therapy for patients who remain PET positive after 2 cycles, which gives rates of disease control of ∼65%. De-escalation by omission of bleomycin and consolidation radiotherapy after a negative interim PET scan seems safe with no increase in recurrence rate, but the performance of interim PET after ABVD is suboptimal, especially for those with very advanced disease at presentation; recurrence rates after a negative scan are ∼15%. The negative predictive value of PET is higher after escalated BEACOPP chemotherapy, and the approach of initially treating with BEACOPP and de-escalating to ABVD for those with negative interim PET scans shows promising early results. Response-adapted therapy has yielded important results for patients with Hodgkin lymphoma and is becoming established as a standard approach.

Absolut Lymphocyte Count At Diagnosis Is Predictive Of Survival In Patients With Classical Hodgkin Lymphoma: A Retrospective Multicenter Brazilian Study

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4236-4236
Author(s):  
Guilherme Fleury Perini ◽  
Egyla M Cavalcante ◽  
Joao Garibaldi Rezende ◽  
Davimar Miranda Borducchi ◽  
Fernanda Cunha Vieira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Lymphocyte Count ◽  
Advanced Disease ◽  
Early Stage ◽  
Absolute Lymphocyte Count ◽  
Refractory Disease ◽  
Advanced Stage ◽  
Classical Hodgkin Lymphoma ◽  
Early Stage Disease ◽  
Stage Disease

Abstract Introduction Classical Hodgkin lymphoma (cHL) is one of the most curable cancers, with cure rates ranging from 65-90%, depending on different risk factors. These factors include both clinical (international prognostic score, IPS) and biological markers (tumor associated macrophages, for example). However, most biological biomarkers are not available in a routine basis and IPS does not offer risk stratification for patients diagnosed with early stage cHL. Recently, Porrata et al described the peripheral lymphocyte/monocyte ratio (LMR) as a strong prognostic factor in patients with cHL. In his study, an LMR of less than 1.1 was related with poor outcome. Objectives To assess the role of lymphocyte/monocyte ratio at diagnosis in predicting outcome and survival in cHL patients in Brazil. Patient and Methods This is a retrospective multicenter study conducted by the Universidade Federal de São Paulo, São Paulo, Brazil. Only confirmed cases of cHL, diagnosed between April 1986 to January 2013, with clinical, epidemiological and laboratorial parameters available after a thorough chart review were included in this study. Response was defined as complete (CR) or less than CR (partial response or refractory disease). Event was defined as treatment related mortality, progression (defined as time for initiation of salvage therapy) or relapse. Advanced stage disease was defined as stage I or II with B symptoms and/or bulky disease and stage III or IV. Patients with conflicted data or loss of follow up were excluded from the analysis. Results A total of 570 patients were diagnosed with cHL in this period. However, 303 patients were selected for this study. Nodular sclerosis subtype was diagnosed in 207 (68%) of all patients. Median age at diagnosis was 30 years old (raging from 12-78), with a 0,9:1 Female:Male ratio. The majority (210, 69%) presented with advanced disease. ABVD chemotherapy protocol was the initial therapy in 91% of patients, MOPP/ABV in 8% and 1% of patients received only radiotherapy. For early-stage disease, a median of 6 cycles was delivered and 8 cycles were given for patients with advanced disease. Consolidation radiotherapy was done in 175 (58%) of all patients after chemotherapy. Overall responses were: CR in 90,7% (n=274), Partial response/Refractory disease in 8,9% (n=27); one patient died due to treatment-related toxicity. CR rates were 97,8% in early stage disease and 89,4% in advanced stage (p=0.07). Overall Survival (OS) for the entire group was 95% in 5 years (CI95% 73-83%), with a progression free survival (PFS) of 78% (CI95% 91-97%). A Lymphocyte/Monocyte ratio (LMR) less than 1.1 was not predictive of survival in our patients, neither PFS (84% vs 78%, p=0.30) nor OS (95% vs 96%, p=0.48). However, absolute lymphocyte count (ALC) greater than 1000 cells/mL at diagnosis was related to a better OS (97% vs 88%, p=0.003). Conclusions Although cHL is highly curable, it is an unmet medical need to better stratify these patients at diagnosis, especially with simple and straightforward prognostic factors, such as absolute lymphocyte count at diagnosis. In our study, LMR less than 1.1 was not associated with survival, as recently pointed by Porrata et al., but an ALC greater than 1000 cells/mL was related to better overall survival. It is well known that the incidence of EBV-related cHL, disease presentation and severity are different in developing countries than in developed ones; therefore, prognostic factors may differ from different studied populations, highlighting the importance of our results. Disclosures: No relevant conflicts of interest to declare.

Lymphocyte-predominant Hodgkin lymphoma: what is the optimal treatment?

Hematology ◽  
2013 ◽  
Vol 2013 (1) ◽  
pp. 406-413 ◽  
Author(s):  
Michelle Fanale
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Radiation Treatment ◽  
Early Stage ◽  
B Cell Lymphoma ◽  
B Cell Lymphomas ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Relapsed Disease

AbstractNodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a unique diagnostic entity, with only ∼ 500 new cases in the United States per year with a similar infrequent incidence worldwide. NLPHL also has distinctive pathobiology and clinical characteristics compared with the more common classical Hodgkin lymphoma (cHL), including CD20 positivity of the pathognomic lymphocytic and histiocytic cells and an overall more indolent course with a higher likelihood of delayed relapses. Given the limited numbers of prospective NLPHL-focused trials, management algorithms historically have typically been centered on retrospective data with guidelines often adopted from cHL and indolent B-cell lymphoma treatment approaches. Key recent publications have delineated that NLPHL has a higher level of pathological overlap with cHL and the aggressive B-cell lymphomas than with indolent B-cell lymphomas. Over the past decade, there has been a series of NLPHL publications that evaluated the role of rituximab in the frontline and relapsed setting, described the relative incidence of transformation to aggressive B-cell lymphomas, weighed the benefit of addition of chemotherapy to radiation treatment for patients with early-stage disease, considered what should be the preferred chemotherapy regimen for advanced-stage disease, and even assessed the potential role of autologous stem cell transplantation for the management of relapsed disease. General themes within the consensus guidelines include the role for radiation treatment as a monotherapy for early-stage disease, the value of large B-cell lymphoma–directed regimens for transformed disease, the utility of rituximab for treatment of relapsed disease, and, in the pediatric setting, the role of surgical management alone for patients with early-stage disease.

Should Albumin Be Considered a Prognostic Factor For Brazilian Patients Diagnosed With Classical Hodgkin Lymphoma

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 5049-5049
Author(s):  
Guilherme Fleury Perini ◽  
Egyla M Cavalcante ◽  
Joao Garibaldi Rezende ◽  
Davimar Miranda Borducchi ◽  
Fernanda Cunha Vieira ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factor ◽  
Partial Response ◽  
Early Stage ◽  
Progression Free Survival ◽  
Refractory Disease ◽  
Advanced Stage ◽  
Classical Hodgkin Lymphoma ◽  
Free Survival ◽  
Stage Disease

Abstract Introduction In 1998, Hasenclever et al published the International Prognostic Factor for patients with advanced stage classical Hodgkin lymphoma (cHL). Since then, the IPS has been considered the most important prognostic score for cHL and has been validated in different populations, and also in early stage cHL. From the seven factors analyzed in the IPS, albumin is the only that can be influenced by environmental, economic and nutritional status. We hypothesized if, in developing countries, albumin should still be a prognostic factor, and if so, what is the ideal cutoff value. Objectives To assess if albumin at diagnosis of cHL patients in Brazil was prognostic for overall survival (OS) and progression free survival (PFS) and what would be the best cutoff. Patient and Methods This is a retrospective multicenter study conducted by the Universidade Federal de São Paulo, São Paulo, Brazil. Only confirmed cases of cHL, diagnosed between April 1996 To January 2013, with clinical, epidemiological and laboratorial parameters available after a thorough chart review were included in this study. Response was defined as complete (CR) or less than CR (partial response or refractory disease). Event was defined as treatment related mortality, progression (defined as time for initiation of salvage therapy) or relapse. Advanced stage disease was defined as stage I or II with B symptoms and/or bulky disease and stage III or IV. Patients with conflicted data or loss of follow up were excluded from the analysis. Results A total of 179 patients were selected for this study. Nodular sclerosis subtype was diagnosed in 125 (68.9%) of all patients. Median age at diagnosis was 28 years old (ranging from 13-76). Only 22.9% of patients presented with early stage disease. ABVD chemotherapy protocol was the initial therapy in 91% of patients. Consolidation radiotherapy was done in 48.6%. Median serum albumin was 3.74 (range: 1.34 – 5.52). Median albumin for patients treated in private hospital was 3.6 (range: 2.7 – 4.7) in contrast to patients treated in public hospitals with a median level of 3.0 (range: 1.34 – 5.52), although this difference was not statistically different. Overall responses were: CR in 90%, Partial response/Refractory disease in 10%; one patient died due to treatment-related toxicity. Overall Survival (OS) for the entire group was 93% in 5 years (CI95% 87-96%), with a progression free survival (PFS) of 79% (CI95% 73-86%). When applying the cutoff of 4g/dL, albumin was not related to OS (91% vs 98%, p=ns) or PFS (85 vs 77%, p=ns). However, an albumin value greater than 2g/dL was related to a better OS (94% vs 71%, p=0.01). Conclusions Prognostic factors may differ from different studied populations. This is particularly truth for albumin, which is the only IPS factor influenced by the environment. In our study, however, albumin was not significantly related to OS or PFS, unless when a cutoff of 2g/dL was used. Disclosures: No relevant conflicts of interest to declare.

Neuroendocrine carcinoma of the cervix: A single institution’s experience.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e15585-e15585
Author(s):  
Megan Preston ◽  
Georgia Anne-Lee McCann ◽  
David M. O'Malley ◽  
Christina Boutsicaris ◽  
Larry J. Copeland ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Metastatic Disease ◽  
Survival Data ◽  
Early Stage ◽  
Stage I ◽  
Stage Ii ◽  
Advanced Stage ◽  
Single Institution ◽  
Early Stage Disease ◽  
Stage Disease

e15585 Background: Neuroendocrine carcinomas (NEC) of the cervix comprise only 2% of all cervical cancers. As a result, prospective data is limited and treatment guidelines rely on literature from lung NEC. The objective of this study was to examine and report on our experience in the management of this rare, aggressive disease. Methods: This was an IRB-approved, single-institution, retrospective review. Study criteria included patients with cervical NEC diagnosed between 1990-2011. Demographic, treatment and survival data was collected. Progression-free survival (PFS) and overall survival (OS) was defined as the time from date of initial treatment until progression or death respectively, or date of last contact. Results: A total of 24 patients met inclusion criteria. The median age at diagnosis was 43. Median PFS was 13.6 months and median OS was 16.4 months. The majority of patients had advanced-stage disease (61% stage II-IV, 39% stage I). Of the 9 patients with stage I disease, 4 were treated with platinum + etoposide-based neoadjuvant chemotherapy and 5 were treated with initial radical surgery. Seven of the 9 patients had post-operative adjuvant therapy consisting of chemotherapy, chemo-radiation or radiation only. Seven of the 9 patients (78%) were alive at last follow-up. Of the two patients who were deceased, one had metastatic disease found at surgery and the other declined adjuvant therapy and died of recurrence. Patients with stage II-IV disease (n=15) had a median PFS and OS of 11.5 and 12.1 months, respectively. Only 2 had no evidence of disease at last encounter. The remainder died without achieving remission. Patients with metastatic disease had significantly worse survival when compared to those with loco-regional disease with a median OS of 8 vs. 28 months (p = .03), respectively. Conclusions: We report one of the largest single-institution experiences of neuroendocrine cervical cancer. Advanced-stage patients had a poor prognosis regardless of therapy. However, multi-modality therapy in early-stage disease resulted in an excellent prognosis (78% survival) for these rare, highly aggressive tumors. These findings support the goal of curative intent for early-stage disease using multi-modality therapy.

scholarly journals Relapse Risk and Loss in Expectation of Lifetime in Young Classical Hodgkin Lymphoma Patients - a Nordic Lymphoma Group Study of 2,582 Patients

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 930-930
Author(s):  
Jorne Lionel Biccler ◽  
Ingrid Glimelius ◽  
Sandra Eloranta ◽  
Knut B. Smeland ◽  
Peter de Nully Brown ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Hodgkin Lymphoma ◽  
Relative Survival ◽  
Advanced Stage ◽  
Classical Hodgkin Lymphoma ◽  
Event Free Survival ◽  
Free Survival ◽  
Relapse Risk ◽  
Limited Stage ◽  
Stage Disease

Abstract Estimates describing the survival and relapse risk for young classical Hodgkin lymphoma (cHL) patients are of considerable interest. A recent population-based study from British Columbia focused on the evolution of the relative survival and relapse risk given that patients reached certain milestones such as two years of relapse-free survival (Hapgood et al. 2016). The study included patients diagnosed before the year 2000 who were treated with regimens that have since been refined. Using register-data from Denmark, Sweden, and Norway, we investigated cHL survivorship in the era of contemporary treatment by inspecting the evolution of relapse risk and loss in life expectancy. Inclusion criteria were: age at diagnosis 18-49 years; diagnosis year between 2000 and 2013; and treatment with chemotherapy (CT) with or without involved node/field radiation therapy (RT). Event-free survival was measured as the time from diagnosis to progression, relapse, or death, whichever came first. The five-year relapse risks from diagnosis and conditional on reaching event-free survival (EFS) milestones were estimated while taking the censoring and competing risk, death, into account. As a measure of relative survival, we estimated the five-year restricted loss in expected lifetime (5y-RLEL), defined as the numeric difference in the number of days a healthy person and a patient with cHL are expected to survive within the next five years. The 5y-RLEL was estimated taking the censoring into account and was estimated for all patients and for those reaching one (EFS1), two (EFS2), or five (EFS5) years of event-free survival. In total, 2,582 cHL patients were included (Denmark n=863, Sweden n=1,236, Norway n=483). The majority were treated with ABVD (n=1,932). Most limited stage (IA-IIA) patients were treated with 2-4 courses of CT and RT with dosage up to 30Gy The majority of the advanced stage (IIB-IV) patients were treated with 6-8 courses of CT +/- RT. A fraction of the patients (n=306) were treated with 6-8 BEACOPP 14 or escalated BEACOPP. Advanced stage patients receiving BEACOPP more often had adverse risk criteria including involvement of the bone-marrow (27% vs 6%) and/or other extranodal sites (60% vs 34%) than advanced stage patients treated with 6-8 cycles of ABVD. The five-year OS was 95.2% (95% CI 94.4 - 96.1) and the five-year risk of relapse was 13.4% (95% CI 12.1-14.8). The dynamic evolution of the five-year relapse risk is shown in Figure 1A and the 5y-RLEL estimates in Figure 1B. For patients reaching the EFS2 and EFS5 milestones, five-year relapse risks were 4.2% (95% CI 3.8 - 4.6) and 0.8% (95% CI 0.8 - 0.9) (Figure 1A), respectively. From diagnosis, the five-year relapse risk for advanced stage patients was twice as high as for limited stage patients, however the difference decreased among patients reaching later EFS milestones and was small after EFS3 irrespective of stage (2.5% [95% CI 2.1 - 2.9] for advanced stage disease vs. 2.0% [95% CI 1.6 - 2.4] for limited stage disease) (Figure 1A). The five-year relapse risk for advanced stage patients treated with 6-8 courses of BEACOPP was comparable to that of advanced stage patients treated with 6-8 courses of ABVD despite more adverse risk criteria among the BEACOPP treated patients (Figure 1A). The 5y-RLEL was limited, e.g. within the first five years post-diagnosis the HL patients were expected to live 46 days (95% CI 35 - 54) less than what was expected for the background population (Figure 1B). Patients reaching the EFS2 milestone had a 5y-RLEL of 13 days (95% CI 7 - 20) and for patients reaching the EFS5 milestone, the 5y-RLEL was 8 days (95% CI 2 - 14) (Figure 1B). Limited stage patients who remained event-free two years post-diagnosis had a minimal 5y-RLEL of 2 days (95% CI -4 - 7) (Figure 1B). By reporting five-year relapse risk and loss of life expectancy overall and conditioned on years in remission, we provide relevant patient-centred prognostic measures for young contemporarily treated cHL patients. The results are reassuring and indicate that limited stage patients who remain event-free two years post-diagnosis have a future life expectancy in line with HL-free individuals. Additionally, irrespective of risk group, the five-year relapse risk was minimal once three years of event-free survival was reached. This information should be taken into account in future surveillance programs. Disclosures Eloranta: Janssen Pharmaceuticals: Other: S Eloranta is currently employed as a project coordinator and her salary is funded via a public-private real world evidence collaboration between Karolinska Institutet and Janssen Pharmaceuticals. Fosså:Janssen Pharmaceuticals, Inc.: Honoraria. Ekstroem Smedby:Janssen Pharmaceuticals: Other: The Department have recieved partial funding from Janssen Pharmaceuticals.

The relationship between tumor size and stage in early versus advanced ovarian cancer: A retrospective chart review

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5580-5580
Author(s):  
L. E. Horvath ◽  
T. Werner ◽  
K. Jones
Keyword(s):  
Ovarian Cancer ◽  
Chart Review ◽  
Advanced Disease ◽  
Early Stage ◽  
Abdominal Cavity ◽  
Advanced Ovarian Cancer ◽  
Retrospective Chart Review ◽  
Advanced Stage ◽  
Early Stage Disease ◽  
Stage Disease

5580 Background: Ovarian cancer has a different prognosis between early (I and II) and advanced stage (III and IV). The mechanism of disease progression is unknown, but patients with advanced disease may have a higher propensity for seeding of the abdominal cavity early in the disease process than those with early stage. Theoretically if this is so, then patients with advanced stage should have smaller sized tumors than patients with early stage. Methods: This was a retrospective chart review of patients in the tumor registry in 2003 to 2006. Patients had epithelial ovarian cancer, other cell types were excluded. Only cases with documentation of surgical and pathologic staging and measured dimensions on pathologic specimen were included. Patient stage and all available dimensions measured on diseased ovaries were recorded. The dimensions for each patient were averaged into a single dimension for that patient, and then these measurements were totaled and averaged. Results: There were 110 patients analyzed: 85 with advanced disease, 25 with early stage. The average measurement was 4.8 cm in advanced disease, and was 10.7 cm in early stage disease. This difference was statistically significant (p < 0.001). Conclusions: Overall, patients with early stage ovarian cancer have diseased ovaries that are more than twice as large as those found in advanced disease. This finding supports the fact that early versus advanced ovarian cancer are 2 separate disease processes. Early stage grows locally and does not disseminate, and advanced stage disseminates while the tumor is still relatively small. Theoretically there may be a factor that separates these 2 into different diseases, where advanced disease patients have a substance produced by their tumor that allows for early dissemination, and early stage lacks this substance and only grows locally. Basic science research comparing the tissue microarrays of early versus advanced stage disease may be able to identify this difference. If the difference is found, perhaps therapy can be targeted against this difference. No significant financial relationships to disclose.

Sign in / Sign up

Export Citation Format

Share Document