HISTOPATHOLOGIC GRADING OF NODULAR SCLEROSIS HODGKINS-DISEASE - LACK OF PROGNOSTIC-SIGNIFICANCE IN 254 SURGICALLY STAGED PATIENTS

Background. The cellular composition of nodular sclerosis Hodgkin's di sease (NS-HD) varies greatly from patient to patient. It is unclear wh ether subclassifying NS-HD based on cellular composition has prognosti c value, because reported studies examining this issue have shown conf licting results. Methods. The initial pathology slides of 254 surgical ly staged patients with NS-HD treated at the Joint Center for Radiatio n Therapy were reviewed and subclassified according to British Nationa l Lymphoma Investigation criteria. The median follow-up time was 123 m onths. Results. A total of 211 patients were classified NS I histology (83%), and 43 patients were classified NS II (17%). There were no dif ferences in the distribution of NS I/NS II patients by age, number of sites of disease, B symptoms, or extent of mediastinal disease. Patien ts with NS II disease were more likely to be male (P = 0.001), and to have pathologic Stage I-II disease (P = 0.07). The 15-year actuarial r ates of disease-free survival were 77 and 80% for NS I and NS II patie nts, respectively (P = not significant). The 15-year overall survival rates were 87 and 93% for NS I and NS II, respectively (P = not signif icant). No differences were seen between NS I and NS II patients for o verall or disease free survival when analyzed separately by pathologic stage or by initial treatment. Similarly, no differences between NS I and NS II patients were seen in the large subgroup of 155 pathologic stage IA-IIA patients treated with radiation therapy alone. When other histologic parameters were analyzed separately, no differences were s een in the frequency of relapse between the groups based on extent of necrosis, atypia, fibrosis, variant atypia, variant syncytia, eosinoph ilia, or number of mitoses. Conclusions. The histologic subclassificat ion of Hodgkin's disease had no prognostic significance in this group of surgically staged, uniformly treated patients.