Long Term Follow-Up Results for Patients with Hodgkin Lymphoma after First Remission of Longer Than Ten Years: A Population Based Study of 954 Patients from the British Columbia Cancer Agency.
Bibliographic record
Abstract
Abstract Background Little information is available regarding the long-term follow-up results in patients with Hodgkin lymphoma (HL) after a first remission for 10 years or longer. The aim of this study is to evaluate the risk of disease relapse, secondary malignancy and causes of mortality in this cohort of patients. Results 954 patients with HL were identified by searching the BC Lymphoid Cancer Database for all patients diagnosed between 1960 and 1995 who had maintained a first remission of greater than 10 y. Median age at diagnosis was 27 y (range 3–73 y) with 83% of patients less than 44 y. Male:female ratio was 1.2:1. The clinicopathological characteristics of the whole cohort are summarized in table 1. The 20- and 30-year OS for the whole cohort were 84% and 64%, respectively. The 20- and 30-year DSS for the whole group were 99% and 98%, respectively. Significant risk factors for lower OS were male gender (20-year OS for males 81%, females 87%, p=0.03), age >44 at diagnosis (20-year OS for age >44 was 51%, <44 was 93%, p<.00001) and mixed cellularity (MC) (20-year OS 81%) compared with nodular sclerosing (NS) (20-year OS 90%), p=0.007. Those factors (sex, age and histological subtype) had no significant impact on the 20-year DSS or PFS. Disease stage and B symptoms had no impact on survival (OS, DSS and PFS). There is no significant difference in the 20- and 30-year OS, DSS or PFS between patients initially treated with radiotherapy alone, chemotherapy alone or a combination of both. Only 24 patients (2.5% of the whole group) had a HL relapse. Six patients had been treated with radiotherapy only, one with radio-chemotherapy and 17 with chemotherapy only. Twelve of these patients have died due to various causes (HL: 7, cardiac disease: 4, lung cancer: 1). There were no risk factors predictive for late relapse (age, stage, histologic type, initial treatment). Secondary cancer was observed in 169 patients (17%) with a median age at cancer diagnosis of 52 years. Extended field radiotherapy (n=108, 64%) and MOPP-like chemotherapy (n=72, 43%) were the most prevalent 2 factors in this group. Breast cancer was the most common malignancy (n=31, median age at diagnosis 47 years), followed by lung (n=25), gastrointestinal (n=21), gynecological (n=20), genitourinary (n=16), hematopoietic (n=15), and thyroid (n=6). In total, 165 patients (17% of the whole group) died after remission of more than 10 y of whom 113 (13% of the whole group) died due to potential complications of primary treatment. The two most common causes of death were secondary malignancies (n=79) and heart diseases (n=34). Only seven patients (0.7%) died due to HL relapse. Conclusion HL relapse is a rare event (< 3%) and death from HL very rare (< 1%) in those who remain in first remission for more than 10 y. Treatment related complications, such as secondary malignancy or ischemic heart disease, are the major causes of mortality. Summary of clinicopathological parameters of patients with HL in first remission for longer than 10 y Parameter Number (954)(%) *Limited: stage I/II, non-bulky (<10 cm in diameter) and no B symptoms. Histology Classical HL 858(90) Nodular sclerosing 610(65) Mixed cellularity 193(20) Lymphocyte-rich/depleted 42/13(4/1) Nodular lym. pred. 11(1) HL not specified 85(9) Stage:Limited*/advanced 445/509(47/53) B symptoms 239(25) Treatment Radiotherapy alone 357(37) Chemotherapy alone 258(27) Combination 337(35)
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".