engleski

Different pattern of prognostic factors is associated with low vs high grade non-Hodgkin's lymphoma. Multivariate analysis of 217 cases in single institution

Non-Hodgkin lymphomas (NHL) are characterized by considerable variability in the course and prognosis. Histologic classification and grouping in high vs. low grade malignancy is still the base in clinical decision making process and planing of therapeutic strategy. Besides that, the accumulation of more adverse prognostic features usually urges clinician to apply more aggressive treatment. To investigate wether the simple parameters routinely taken at diagnosis are prognostically useful, uni- and multivariate analyses of 54 distinct parameters were done in 217 newly diagnosed patients with NHL in Clinical hospital "Merkur" between 1986 and 1991. Median age at diagnosis was 55 years (range 14–). Male to female ratio was 115/102. According to Kiel classification 142 (65%) patients had high grade, and 75 (35%) had low grade malignancy NHL, having significantly different median survival (24 vs. 60 months, p = 0.0030). 39 clinical, histological, immunological, hematological, biochemical parameters were entered in Cox multivariate analysis. In whole series the following parameters entered the model at a significant level (global chi-square = 73.07): age (p = 0.000), copper (p = 0.000), histological grade (p = 0.002), uric acid (p = 0.005), hemoglobin (p = 0.012), and WBC (0.013). Out of same parameters in high grade lymphomas we found (global chi-square = 54.26): age (p = 0.000), hemoglobin (p = 0.001), uric acid (p = 0.004), WBC (0.010), IgM (p = 0.050) and bone marrow infiltration (p = 0.061), as distinct form low grade lymphomas (global ?2 = 57.33): LDH (p = 0.000), age (p = 0.005), sex (p = 0.003), phosphorus (p = 0.017), total serum protein (p = 0.037) and hemoglobin (p = 0.050). We conclude that 1) the difference in prognostic factors pattern suggests more fundamental biological differences between high and low grade lymphomas and 2) that in the process of clinical decision making, knowledge of the distinct pattern of prognostic factors could improve the efficacy of therapeutic decisions.

prognosis; non-Hodgkin's lymphoma

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