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背景与目的:霍奇金病(Hodgkinsdisease,HD)是对放化疗敏感的恶性肿瘤,如何提高HD的治疗效果,同时尽量避免不良反应、使患者保持良好的生活质量是目前临床研究的关键问题。本研究回顾性分析我院近30年治疗HD的长期随访结果,以了解HD的远期疗效和不良反应发生情况。方法:回顾性分析1970～2000年间295例HD的临床资料,着重分析1980～2000年间资料比较完整的182例,采用多因素分析方法(Cox模型)分析HD患者的临床特征及治疗方法和预后的关系。结果:295例HD患者均采用以化疗为主的综合方法治疗,中位随访42.9个月(17.0～351.9个月),5、10和20年生存率分别为63.5%、55.8%和47.1%,中位生存期172.3个月(28.0～351.9个月)。其中1980年以后的182例患者采用了比较正规的化疗和放射治疗,5、10、20年生存率及无病生存率分别为79.6%、74.5%、66.8%及74.5%、69.4%、69.4%;远期不良反应发生率低。另外,本组多因素分析结果表明,年龄≥45岁、Ⅲ～Ⅳ期和B症状是预后危险因素(P=0.000,P=0.035和P=0.047)。进一步分析发现,Ⅰ～Ⅱ期比Ⅲ～Ⅳ期预后好,结节硬化型比其他病理类型的预后好。结论:采用以全身化疗为主结合侵犯野放疗的综合方法治疗HD,远期生存率较高,不良反应发生率低,同时该治疗方法简便,适应性强,值得临床推广。
BACKGROUND & OBJECTIVE: Hodgkinsdisease (HD) is a malignant tumor that is sensitive to radiotherapy and chemotherapy. How to improve the therapeutic effect of HD while avoiding adverse reactions and maintaining good quality of life for patients is a key issue in clinical research. This study retrospectively analyzed the long-term follow-up results of treatment of HD in our hospital in the past 30 years to understand the long-term effect of HD and the occurrence of adverse reactions. Methods: The clinical data of 295 cases of HD from 1970 to 2000 were retrospectively analyzed. The data of 182 cases with complete data from 1980 to 2000 were analyzed. The clinical characteristics, treatment and prognosis of HD patients were analyzed by multivariate analysis (Cox model) relationship. Results: A total of 295 HD patients were treated with chemotherapy. The median follow-up was 42.9 months (17.0 ~ 351.9 months), and the 5, 10 and 20-year survival rates were 63.5%, 55.8% and 47.1% The median survival time was 172.3 months (28.0 ~ 351.9 months). Among them, 182 patients after 1980 adopted the more regular chemotherapy and radiotherapy. The 5-year, 10-year and 20-year survival rates and disease-free survival rates were 79.6%, 74.5%, 66.8% and 74.5%, 69.4% and 69.4% ; Long-term adverse reaction rate is low. In addition, the group multivariate analysis showed that age ≥ 45 years, stage Ⅲ ~ Ⅳ and B symptoms are risk factors for prognosis (P = 0.000, P = 0.035 and P = 0.047). Further analysis found that stage Ⅰ ~ Ⅱ than stage Ⅲ ~ Ⅳ prognosis is good, tuberous sclerosis than other pathological types of prognosis. Conclusion: The treatment of HD combined with systemic chemotherapy combined with invasive radiotherapy has higher long-term survival rate and lower incidence of adverse reactions. At the same time, the treatment is simple and adaptable and worthy of clinical promotion.