HODGKINS-DISEASE - CORRELATION OF CLINICAL CHARACTERISTICS WITH PROBABILITIES FOR NEGATIVE LYMPHANGIOGRAM VS. NEGATIVE LAPAROTOMY FINDINGS IN PATIENTS WITH STAGE-I SUPRADIAPHRAGMATIC PRESENTATIONS VS. THOSE INPATIENTS WITH STAGE-II

Purpose: At a time both when late complications and second malignancie s have become a growing concern and when staging laparotomy has been l argely abandoned and comparative studies for staging Hodgkin's disease by state of the art computed tomography (CT) vs. lymphangiography hav e revealed minimal differences in results for these procedures, our pu rpose for undertaking this study was twofold. Our initial reason was t o determine and compare probabilities for negative abdominal findings for patients with Stage I presentations with those for patients with S tage II as determined by lymphangiography and subsequently by laparoto my for those patients who had negative lymphangiograms. Our second rea son, being an extension of the first, was to create a resource that ca n be used in conjunction with other information for arriving at approp riate treatment decisions including giving either more or particularly less than standard institutional therapy and especially with respect to the abdomen. Methods and Materials: Data on 714 patients with prely mphangiogram Stage I-II upper torso presentations of Hodgkin's disease were entered prospectively in our database between 1968 and 1987. Twe nty-eight with lymphocyte predominant disease, who had both negative l ymphangiogram and negative laparotomy findings and 17 with questionabl e diagnoses of lymphocyte-depleted or unclassified disease were exclud ed from subsequent analyses of 669 patients with nodular sclerosis (NS ) and mixed cellularity (MC) diagnoses. Results: Stage I: in final log istic models, negative lymphangiogram findings were associated strongl y with a combination of no constitutional symptoms and nodular scleros is histology, whereas negative laparotomy findings correlated strongly with a combination of no constitutional symptoms and female sex. Pred icted probabilities depended on the ratios of favorable to unfavorable characteristics. Stage II: in final logistic models, negative lymphan giogram findings were associated strongly with a combination of no con stitutional symptoms, nodular sclerosis histology, age <40 years, and <4 involved sites, whereas negative laparotomy findings correlated str ongly with a combination of <4 involved sites and mediastinal disease. Predicted probabilities again depended on the ratios of favorable to unfavorable characteristics. Conclusion: This study demonstrated that probabilities for negative abdominal findings for patients with suprad iaphragmatic presentations of NS and MC Hodgkin's disease depended on: 1) whether the disease presented as Stage I or as Stage II; 2),whethe r staging was limited to a lymphangiogram or whether it included a lap arotomy; and 3) or whether the clinical features associated with the p resenting stage and methods of staging were favorable or unfavorable. (C) 1998 Elsevier Science Inc.