Background: Large mediastinal tumor is considered as an unfavorable prognostic factor for Hodgkin’s lymphoma (HL). Patients with advanced Ann Arbor clinical stages (CS III and IV) are considered as advanced disease. Nevertheless, some study groups are also stratifying patients with large mediastinal tumor as advanced disease.
Aim: The aim of this study was to assess the outcome of ABVD treated HL patients with large mediastinal tumor, as well to identify risk factors for poor outcome.
Patients and methods: A study was performed on 173 HL patients with large mediastinal tumor (more than one-third of the maximum horizontal chest diameter on CXR) diagnosed between 1997 and 2011. The standard initial treatment was 6-8 cycles of ABVD +/- radiotherapy. Beside the patients with advanced CS, this study also included patients wirh CS II who were according to institutional guidelines treated the same as patients with advanced CS.
Results: The median age was 29 (range 16-68). The median follow up was 94 months. Five-year event free survival (EFS) was 62% and 5-year overall survival (OS) was 76%. In univariate analysis, there was no difference in survival based on CS, both in OS (log rank; p=0.180) and EFS (log rank; p=0.126). Worse OS was found only in patients with IPS≥3 (5-year OS 62.5% vs. 82.1%; log rank, p=0.011), while presence of age>45, male gender, ESR≥50 mm/h, B symptoms or EN disease didn’t influence OS (log rank; p=0.499, p=0.145, p=0.631, p=0.111, p=0.900, respectively). Worse EFS was found in patients with IPS≥3 (5-year EFS 51.8% vs. 67.6%) and males (5-year EFS 54.8% vs.66.7%) (log rank; p=0.037, p=0.016, respectively), while presence of age>45, ESR≥50 mm/h, B symptoms or EN disease didn’t influence EFS (log rank; p=0.960, p=0.885, p=0.295, p=0.887, respectively). The multivariate Cox regression analysis identified IPS≥3 as the independent prognostic factor for OS (p=0.023; RR=1.982; 95% CI 1.100-3.570) and male gender for EFS (p=0.011; RR=1.852; 95% CI 1.153-2.974).
Conclusion: The initial approach in patients with CS II and large mediastinal tumor shouldn’t be different from advanced clinical stages. More effective approach seems to be required, especially in males and patients with high IPS.