Prognostic factors in Hodgkin's disease: Multivariate analysis of 327 patients from a single institution

On the basis of a retrospective study of 327 patients with Hodgkin's diseas e (HD), the prognostic significance of several factors, accepted previously and recently proposed, has been analyzed with regard to response to treatm ent and the survival time. Multivariate regression analysis strongly decrea sed the number of potentially prognostic parameters. The only independent, pretreatment factors negatively influenced by either time of survival or re sponse to treatment were the following: age at diagnosis of more than 45 ye ars, advanced (IIIB/IV) clinical stage, poor clinical status according to K arnofsky's scale (score less than 70), presence of systemic symptoms, mixed cellularity/lymphocyte depletion histological type, multisite peripheral n odal localization of the disease, abdominal lymphadenopathy, and large prim ary tumor mass (bulky disease), Short time to achieve complete remission (d uring the first four courses of chemo therapy) has proven to be significant ly positive predictive factor. Cumulative dose of cytostatics lower than pr ogrammed was a significantly negative prognostic factor that correlated wit h a shorter time of survival, Lack of or a too-low dose of radiotherapy had the same predictive value, High activity of serum lactate dehydrogenase co rrelated moderately with poor response to the first-line treatment but did not influence the survival time. Other clinical, morphological, and biochem ical parameters influenced neither the prognosis nor the response to treatm ent, Additionally, immunohistochemical examinations for proliferating cell nuclear antigen and the protein products of the p53 and bcl-2 genes were pe rformed on the lymph nodes obtained from the patients with HD, High express ion of proliferating cell nuclear antigen, p53, and BCL-2 correlated with p oor response to the treatment and/or short time of survival. Statistical an alysis has led us to the conclusion that the pretreatment expression of the se oncoproteins can be taken into consideration as a new prognostic factor in HD.