Contributions
Abstract: PB1552
Type: Publication Only
Session title: Hodgkin lymphoma - Clinical
Background
While the majority of Hodgkin lymphoma (HL) patients are curable, some patients with advanced disease still relapse and have poor prognosis. Although the International Prognostic Score (IPS) or a modified IPS were developed to predict prognosis, therapeutic and imaging modalities of HL have improved over time and their impact among different risk groups has diminished nowadays. It is crucial to identify and assess new prognostic factors in advanced HL patients.
Aims
To identify and assess the prognostic factors for newly-diagnosed HL (NDHL) patients with stage III/IV in Taiwan.
Methods
This study used Taiwan’s National Health Insurance Research Database and the Taiwan Cancer Registry. All NDHL patients with stage III/IV who underwent front-line therapy with ABVD or ABVD-like regimens (the standard of care) between 2009 and 2016 enrolled. We randomly split these patients into the development and validation samples by a ratio of 80:20. Cox proportional hazards models were used to identify prognostic factors for overall survival (OS) and time to next treatment (TTNT, as a surrogate for progression-free survival, PFS). Factors with a p-value <0.25 in the univariable model were included in the multivariable model. In the multivariable model, factors with a p-value <0.05 were considered significant, and adjusted hazard ratios (aHRs) with 95% confidence interval (CI) were estimated. Additionally, we used the time-dependent area under the receiver operating characteristic curve (AUC) to assess the model performance.
Results
A total of 459 NDHL patients with stage III/IV were included. At a median follow-up of 4.7 years, the OS was 76%. The median TTNT was 5.1 years. There were 359 and 100 patients in the development and validation samples, respectively. Age (45-59 years: aHR 2.4 [95% CI 1.2-4.7], 60 years or older: aHR 9.9 [5.9-16.8]; both compared to age <45) and extra-nodal disease (aHR 1.8 [1.1-2.9]) were significant factors associated with a shorter OS in the final model. The mean time-dependent AUC was 0.82 in the development sample and 0.81 in the validation sample. With regard to disease progression, patients with older age (45-59 years: aHR =1.2 [0.8-1.9], 60 years or older: aHR 2.3 [1.6-3.3]) and extra-nodal disease (aHR 1.5 [1.1-2.1]) also had significantly shorter TTNT. The mean time-dependent AUC was 0.61 in the development sample and 0.65 in the validation sample.
Conclusion
In NDHL patients with stage III/IV, older age and extra-nodal disease were important prognostic factors for both shorter OS and shorter TTNT. Furthermore, the discrimination ability of the OS model was excellent. Since laboratory data were not available in the present study, further studies that evaluate all HL-related clinical factors may be required to validate the findings and provide a more comprehensive evaluation.
Keyword(s): Hodgkin's lymphoma, Prognostic factor
Abstract: PB1552
Type: Publication Only
Session title: Hodgkin lymphoma - Clinical
Background
While the majority of Hodgkin lymphoma (HL) patients are curable, some patients with advanced disease still relapse and have poor prognosis. Although the International Prognostic Score (IPS) or a modified IPS were developed to predict prognosis, therapeutic and imaging modalities of HL have improved over time and their impact among different risk groups has diminished nowadays. It is crucial to identify and assess new prognostic factors in advanced HL patients.
Aims
To identify and assess the prognostic factors for newly-diagnosed HL (NDHL) patients with stage III/IV in Taiwan.
Methods
This study used Taiwan’s National Health Insurance Research Database and the Taiwan Cancer Registry. All NDHL patients with stage III/IV who underwent front-line therapy with ABVD or ABVD-like regimens (the standard of care) between 2009 and 2016 enrolled. We randomly split these patients into the development and validation samples by a ratio of 80:20. Cox proportional hazards models were used to identify prognostic factors for overall survival (OS) and time to next treatment (TTNT, as a surrogate for progression-free survival, PFS). Factors with a p-value <0.25 in the univariable model were included in the multivariable model. In the multivariable model, factors with a p-value <0.05 were considered significant, and adjusted hazard ratios (aHRs) with 95% confidence interval (CI) were estimated. Additionally, we used the time-dependent area under the receiver operating characteristic curve (AUC) to assess the model performance.
Results
A total of 459 NDHL patients with stage III/IV were included. At a median follow-up of 4.7 years, the OS was 76%. The median TTNT was 5.1 years. There were 359 and 100 patients in the development and validation samples, respectively. Age (45-59 years: aHR 2.4 [95% CI 1.2-4.7], 60 years or older: aHR 9.9 [5.9-16.8]; both compared to age <45) and extra-nodal disease (aHR 1.8 [1.1-2.9]) were significant factors associated with a shorter OS in the final model. The mean time-dependent AUC was 0.82 in the development sample and 0.81 in the validation sample. With regard to disease progression, patients with older age (45-59 years: aHR =1.2 [0.8-1.9], 60 years or older: aHR 2.3 [1.6-3.3]) and extra-nodal disease (aHR 1.5 [1.1-2.1]) also had significantly shorter TTNT. The mean time-dependent AUC was 0.61 in the development sample and 0.65 in the validation sample.
Conclusion
In NDHL patients with stage III/IV, older age and extra-nodal disease were important prognostic factors for both shorter OS and shorter TTNT. Furthermore, the discrimination ability of the OS model was excellent. Since laboratory data were not available in the present study, further studies that evaluate all HL-related clinical factors may be required to validate the findings and provide a more comprehensive evaluation.
Keyword(s): Hodgkin's lymphoma, Prognostic factor