Clinical staging of adult non-Hodgkin's lymphoma

In this study an attempt is made to propose a working clinical classification and staging of adult non-Hodgkin's lymphoma (NHL) which brings out both primary site and extent of disease. Unlike childhood NHL, where histopathology is uniformly of unfavourable type, this clinical staging system seems to have a prognostic value when applied with reference to different histology groups of working formulation. Based on the experience of staging of childhood NHL as proposed earlier, 304 cases of adult NHL above 14 years of age seen at Kidwai Memorial Institute of Oncology, Bangalore, India, over a period of 5 years (1981-1985) are first categorized according to primary site (initial bulky site at presentation): (1) peripheral nodal (n = 181; (2) extranodal (excluding gastrointestinal tract; n = 48); (3) abdominal (including gastrointestinal tract; n = 46), and (4) mediastinal (n = 29). Each group is further staged according to the extent of the disease. Once categorized into various clinical groups, the Ann Arbor Clinical staging fits very well only with the peripheral nodal group, the major group, although not suitable for other clinical groups.