Stage I and II subdiaphragmatic Hodgkin's disease

Article Abstract:

Hodgkin's disease is a malignant growth of lymphatic tissues that may ultimately spread to other organs. The disease often begins in lymph nodes of the chest. Curiously, the characteristics of the disease seem to be somewhat different when the disorder arises above the diaphragm than when it arises below it. Hodgkin's disease arising below the diaphragm is less common, accounting for less than 10 percent of all cases. In all forms, Hodgkin's disease affects men more often than women, but for disease below the diaphragm, the male-to-female ratio is even higher. Patients with disease below the diaphragm also tend to be older when first diagnosed than patients with disease above the diaphragm. A study was conducted of 258 patients with Hodgkin's disease in Stage I or Stage II. Of these, only 19 had Hodgkin's disease below the diaphragm. The average age of these patients was 42, in contrast with the average age of the remaining patients which was 28. The survival rate after 10 years was 73 percent for the patients presenting with disease below the diaphragm, in contrast with 81 percent for patients with disease above the diaphragm. This difference was not statistically significant, however. A key factor contributing to the survival of patients with disease below the diaphragm was whether the Hodgkin's disease was limited to the peripheral lymph nodes or whether the initial disease was present in the abdominal cavity itself. Sixty percent of the patients with disease in the abdominal cavity died, while all of the patients with disease below the diaphragm involving only the lymph nodes survived. These observations suggest that radiation therapy alone is successful for patients with disease below the diaphragm limited to the lymph nodes. For patients with Hodgkin's disease in the abdominal cavity, however, therapy consisting of both radiation therapy and chemotherapy might be most appropriate. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Relationship of histopathologic features to survival and relapse in nodular sclerosing Hodgkin's disease: a study of 1659 patients

Article Abstract:

Nodular sclerosing (NS) Hodgkin's disease has certain features, including nodular growth and intranodal collagen bands, which distinguish it from other subtypes of Hodgkin's disease. Since NS Hodgkin's has not been observed to transform into other subtypes, nor have other subtypes been seen to transform into NS, it has been recommended that the classification of nodular sclerosing Hodgkin's disease take precedence over other histological features. The nodules of NS may show a variety of different cell types; in order to determine the relationship between the histological (tissue) type of NS and the prognosis, a total of 1,659 pathological specimens were reviewed. The stage of the patients' disease ranged from I to IV. Examination revealed that the presence of areas of numerous anaplastic cells, which have lost their resemblance to their normal adult form, or areas of lymphocyte depletion is associated with poor response to initial therapy, increased risk of relapse, and decreased chances of survival. These histological features have been termed Grade II NS, while the variety of other features, which were not found to affect prognosis, were termed Grade I NS. The features distinguishing Grades I and II are easy to observe, and the distinction may be important for identifying patients in need of more aggressive therapy to improve their chances for survival. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Survival of the older patient compared with the younger patient with Hodgkin's disease: influence of histologic type, staging, and treatment

Article Abstract:

Older patients with Hodgkin's disease suffer a significantly poorer prognosis than do younger patients. However, the cause for this is not clear. Determining the true nature of the relationship between age and prognosis requires that confounding factors be properly controlled for. For example, older patients may be more conservatively staged, which would increase their risk. Younger patients might be treated more aggressively and watched more closely, optimizing their chances. In an effort to evaluate the effect of age on the prognosis of Hodgkin's disease, data on 6,345 patients collected by the Patterns of Case Study sponsored by the American College of Surgery were used. These data provide information on 19 clinical and 11 pathological tests, as well as clinical stage and pathologic stage. This permitted the comparison between older and younger patients who were graded and treated equivalently. Although the matching reduced the apparent size of the age effect, there remained nonetheless a significantly poorer prognosis for older people with Hodgkin's disease than younger. While factors such as disease stage correlate with age, age is an independent predictor of poorer prognosis in Hodgkin's disease patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Patient outcomes, Mortality, Demographic aspects

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