Survival in Hodgkin's disease: the role of immunocompetence and other major
risk factors
GB Faguet and HC Davis
The prognostic value of age, sex, symptoms, histopathology, lymphocyte
count, skin tests, immunocompetence (lymphocyte response profile to a
spectrum of PHA concentrations), and stage was evaluated in 35 previously
untreated patients with Hodgkin's disease by multiple linear regression and
logistic analysis. Immunocompetence exhibited the highest correlation (R =
0.537) with survival status and was required as a common denominator for
deriving best sets of two or more variables. In addition, immunocompetence
contributed to all other variables combined (p = 0.023), whereas stage did
not (p = 0.116). Immunocompetence, age, symptoms, and histopathology
generated a highly discriminant (R = 0.784) model not improved by stage or
by other variables (p greater than or equal to 0.159). The utility and
generalizability of this model are shown by a correct classification of
91.2% of cases according to expected versus actual survival status and by a
predicted correlation (R) of 0.71, respectively, neither improved by sex,
lymphocyte count, skin tests, or stage. In comparison, the conventional
triad of stage, symptoms, and histopathology correctly classified only
70.6% of cases and showed actual and predicted correlations with survival
status of R = 0.550 and R = 0.51. We conclude that immunocompetence is a
powerful discriminant risk factor in Hodgkin's disease that exerts a
pivotal role on survival and serves as a basis for models of greater
discriminant power and generalizability than the conventional stage-based
evaluation triad. Immunocompetence-based models are expected to provide a
more discriminating basis for clinical evaluation, prediction of prognosis,
and treatment selection for patients with Hodgkin's disease.
Volume 59,
Issue 5,
pp. 938-945,
05/01/1982
Copyright © 1982 by The American Society of Hematology
