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[Feasibility study of application of international prognostic score on prediction of prognosis for advanced Hodgkin's
Xiao-Hong Fu1, Shu-Sen Wang, Yan Huang
1State Key Laboratory of Oncology in South China, Guangzhou, Guangdong, 510060, P. R. China.
Background & Objective:
Currently, 60% patients with advanced Hodgkin's lymphoma could be cured by receiving standard treatments. The international prognostic factor project on advanced Hodgkin's lymphoma has developed a concept of international prognostic score (IPS) based on seven adverse prognostic factors consisting of male sex, age 45 years or older, stage IV disease, leukocytosis, lymphocytopenia, low hemoglobin and low serum albumin for newly diagnosed advanced Hodgkin's lymphoma patients. This study was to explore the feasibility of the international prognostic score in advanced Hodgkin's lymphoma.
Methods:
We performed a retrospective review of 141 patients with untreated advanced Hodgkin's lymphoma in Cancer Center of Sun Yat-sen University between January 1980 and December 2004. IPS was defined as the number of adverse prognostic factors presented at diagnosis. The rates of failure free survival (FFS) and overall survival (OS) were estimated using the method of Kaplan-Meier and compared according to IPS by log-rank test. Cox proportional hazard model was used in multivariate analysis.
Results:
The 5-year FFS and OS for 141 advanced Hodgkin's lymphoma patients were 57.6%, 68.1% respectively. Estimated 5-year FFS was 67.7%, 63.2%, 61.8%, 34.9% for patients with 0-1, 2, 3, > or =4 of the adverse prognostic factors respectively. Estimated 5-year OS was 81.0%, 75.5%, 70.3%, 42.3% for patients with 0-1, 2, 3, > or =4 of the adverse prognostic factors respectively. The 5-year FFS for low risk patients with IPS=0-2 and high risk patients with IPS> or =3 were 65.4%, 48.9% respectively (log-rank test: P=0.012); the 5 year OS for patients with IPS=0-2 and IPS> or =3 were 78.4%, 57.1% respectively (log-rank test: P=0.004). Low risk patients with IPS=0-2 had superior overall survival than high risk patients with IPS> or =3 when treated with ABVD or MOPP. The FFS and OS of the advanced HL patients at high risk treated with ABVD were better than those treated with MOPP. Multivariate analysis demonstrated that B symptoms, extranodal disease and MOPP chemotherapy were independent adverse prognostic factors for FFS and OS.
Conclusions:
The IPS shows good prognostic power in advanced HL. High risk advanced HL patients treated with MOPP have inferior survival than those treated with ABVD, thus we recommend patients to be treated with ABVD or more intensive regimen.
