Purpose: Risk stratification is a key factor,which depends on staging, clinical and laboratory parameters in determining the treatment in Hodgkin’s lymphoma (HL). However, this is highly prone to erroneous results due to overlapping components in the staging systems and inter-observer variability.We conducted this study to assess the reliability of risk stratification performed by our clinicians at our busy multidisciplinary clinic (MDC).
Methods: A retrospective analysisof newly diagnosed HL patients from the multidisciplinary clinic database for the year 2016-18was conducted.All patients underwent an 18-FDG PET/CT scan and other evaluations as per our institutional checklist. The reliability of staging and risk stratification done during the MDC was compared with a team of independent experts (medical oncology, radiation oncology and nuclear medicine) based on a standard reference. The concordance testing was done using kappa statistic for agreement (≥ 0.8 as perfect agreement) andP <0.05 was considered significant.
Results: 120 patients were analyzed, and the baseline characteristics are described in Table 1. The patients initially underwent staging by MDC and were risk stratified into early favorable (16 patients [13.5%]), early unfavorable (29 patients [24%]) and advanced (75 patients [62.5%]). A discordance rate of 10% (12 patients) was observed in disease staging and 8.3% in risk stratification (10 patients) between the MDC and the expert team. All deviations were due to up-staging of patients by MDC, of which 9 patients in early favorable were misclassified as early unfavorable and 1 patient as advanced from early unfavorable. This resulted in 10 patients receiving higher dose of chemotherapy and radiation. However, no patients were under treated. On completion of treatment, 82%of patientshadcomplete response, 12%had partial responseand 5%had disease progression. Our results show that the discordance rates were not significantbetween the independent reviewers and MDC team with kappa score of 0.859 for stagingand 0.847 for risk stratification.
Conclusion: Despite our busy setting, the risk stratification was found to be reliable and comparable to reference standards. One reason for this would be the involvement of a multidisciplinary team in our lymphoma clinic. Yet, 8% of the patients received a more intense therapy than needed, demonstrating the need for a simpler, objective and technology driven risk stratification process.
Hasmukh Jain, Ajay Singh, Manju Sengar, Thomas Eipe, Hiral Mehta, Bhausaheb Bagal, Jayashree Thorat, Lingaraj Nayak, Neha Sharma