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. 2016 Jun;5(6):997-1003.
doi: 10.1002/cam4.655. Epub 2016 Mar 21.

Improved survival time trends in Hodgkin's lymphoma

Matthew Koshy  1   2 , Andrew Fairchild  1 , Christina H Son  2 , Usama Mahmood  3
Affiliations

Improved survival time trends in Hodgkin's lymphoma

Matthew Koshy et al. Cancer Med. 2016 Jun.

Abstract

There have been dramatic changes in the staging and treatment of Hodgkin's lymphoma (HL) over the past 30 years. We undertook this study to determine if a stage migration had occurred and also examined if treatment associated with later years has improved survival. Patients with stage I-IV HL between 1983 and 2011 were selected from the Surveillance, Epidemiology, and End Results database. Multivariable analysis (MVA) was performed using Cox proportional hazards modeling. The study cohort included 35,680 patients. The stage breakdown in 1983 according to A and B symptoms was follows: 18%, 21%, 12%, and 5% for stage IA, IIA, IIIA, and IVA disease, respectively, and 6%, 11%, 12%, and 15% for stage IB, IIB, IIIB, and IVB disease. The stage breakdown in 2011 according to A and B symptoms was follows: 9%, 29%, 10%, and 6% for stage IA, IIA, IIIA, and IVA disease, respectively, and 4%, 16%, 12%, and 13% for stage IB, IIB, IIIB, and IVB disease. The median follow-up for the entire cohort is 6.1 years. On MVA, the HR for mortality of patients diagnosed in 2006 was 0.60 (95% Confidence Interval (CI): 0.52-0.70) compared to 1983. For stage I and II patients diagnosed in 2006 the HR was 0.62 (95% CI: 0.44-0.87) and 0.40 (95% CI: 0.30-0.55), respectively, compared to patients diagnosed in 1983. For stage III and IV patients diagnosed in 2006 the HR was 0.72 (95% CI: 0.53-0.98) and 0.74 (95% CI: 0.56-0.99), respectively, compared to patients diagnosed in 1983. This is the first study to demonstrate a significant stage migration in early stage Hodgkin's lymphoma. Furthermore, these results demonstrate an improvement in survival over time for patients with Hodgkin's lymphoma which was particularly notable for those with early stage disease.

Keywords: Lymphoma; stage migration; time trends.

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Figures

Figure 1
Figure 1
Stage Migration for Hodgkin's lymphoma from 1983 to 2011.
Figure 2
Figure 2
5 year Kaplan–Meier estimates of overall survival for stage I–IV patients with Hodgkin's lymphoma stratified by year of diagnosis.
Figure 3
Figure 3
Multivariate Analysis of Survival for Hodgkin's Lymphoma, Stages I‐IV, with Forest Plot Depicting Adjusted Hazard Ratio (95% Confidence Interval) of Survival Stratified by Year of Diagnosis Compared to 1983 as the referent group.
Figure 4
Figure 4
Multivariate Analysis of Survival for Hodgkin's Lymphoma, Stratified by Stage, with Forest Plot Depicting Adjusted Hazard Ratio (95% Confidence Interval) of Survival by Year of Diagnosis Compared to 1983 as the referent group.
See this image and copyright information in PMC

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