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  • 1
    ISSN: 1432-0584
    Keywords: Key words Hodgkin' s disease ; Liver biopsy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Liver biopsy is an invasive diagnostic method for detecting liver involvement (LI) in Hodgkin's disease (HD). The aim of this retrospective study was to determine and evaluate a method for restricting liver biopsy to a subset of patients. Between 1988 and 1994, a total of 2016 patients with HD were treated within the HD4–6 study protocol of the German Hodgkin's Lymphoma Study Group (GHSG). We investigated the predictive power of abdominal ultrasound (US) and computed tomography (CT), as well as of various clinical factors related to LI, using univariate and multivariate methods. LI occurred in 4.9% of all patients (99/2016) and in 3.0% of those who, if LI were disregarded, would have been included in clinical stages I and II. In multivariate analysis the presence of LI was significantly associated with splenic involvement or infradiaphragmatic involvement, absence of mediastinal involvement, serum alkaline phosphatase (SAP) level over 230 units/l, and age over 40 years. We used these factors to define a risk score for LI. LI is very rare in patients who would otherwise be in clinical stages I or II, but knowledge of LI is important because it has therapeutic consequences. With our risk score, liver biopsy is indicated for approximately one quarter of these patients otherwise in clinical stages I or II.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1569-8041
    Keywords: disease free survival ; early stage Hodgkin's disease ; prognostic factor ; prognostic index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background:The seven-factor International Prognostic Score (IPS)has been developed and verified for patients with advanced stage Hodgkin'sdisease (HD). This report aims to assess the predictive power of the IPS forearly stage HD patients. Patients and methods:Data on patient characteristics, therapy andfollow-up were available for 1424 adult patients in clinical stagesI–IIIA treated for primary HD in two German Hodgkin's Lymphoma StudyGroup (GHSG) trials (1988–1994). Patients with risk factors or in stageIIIA received chemo–radiotherapy (CMT; trial HD5); others receivedextended field radiotherapy (RT) alone (HD4). The IPS could be calculated for712 HD5 and 249 HD4 patients (70%). The prognostic value of the IPS andits component factors was assessed using Cox proportional hazards regression.A search was made for additional factors which could add predictive power tothe IPS. Results:The IPS identified 40% of the unfavourable earlystage patients with an 8% lower disease-free survival at six years(hazard ratio 1.66, P = 0.0018). The factor ‘low albumin’ was theonly score component giving a significant individual contribution. Allowingfor the IPS, extranodal involvement, particularly in stages IIB–IIIA,was associated with worse prognosis, but no further significantly prognosticfactors were revealed. The IPS identified a similar hazard ratio in HD4,although here the effect was not significant. Conclusions:The IPS for advanced HD has modest predictive abilityin unfavourable early stage patients. Modification of the IPS for use withearly stages may improve its prognostic power.
    Type of Medium: Electronic Resource
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