Author reply

Abstract

W e read with interest the article by Maucort-Boulch et al. regarding a new prognostic scoring system for Hodgkin lymphoma.1 In a series of 955 patients treated between 1981 and 1996, the authors found that only 4 variables present at diagnosis (age, number of lymphoid areas, visceral involvement, and B-symptoms) remained associated with overall survival (OS) on multivariate analysis. The 4 variables were used to identify 6 prognostic groups according to a point system. These groups were then joined to build a 3-stage prognostic scoring system (PSS), the discrimination and prediction properties of which were found to perform better than other prognostic scores tested.We have applied the PSS in a series of 370 patients with Hodgkin lymphoma who were treated with the combination of doxorubicin, bleomycin, vinblastine, and dacarbazine between 1996 and 2005 in 2 public institutions. The median age of the patients was 29 years (range, 15-82 years). There were 197 men (53%) and 173 women. Localized disease, defined as Ann Arbor stages IA-IIA, was present in 151 patients (41%), whereas advanced disease was present in 219 patients. With a median follow-up of 3.92 years in surviving patients, the 5-year OS rate was 87%.The patient distribution across the 6 prognostic groups was: 84 patients in Group 0 (23%), 104 patients in Group 1 (28%), 81 patients in Group 2 (22%), 54 patients in Group 3 (14.5%), 35 patients in Group 4 (9.5%), and 12 patients in Group 5 (3%). The 5-year OS rates for these groups were 97%, 93%, 80%, 77%, 86%, and 67%, respectively (P ¼ .0004). The 5-year progression-free survival (PFS) rates of these same groups were 86%, 86%, 74%, 63%, 73%, and 67%, respectively (P ¼ .005).When the PSS was applied, the 5-year OS rates for the early (Groups 0 and 1), intermediate (Groups 2 and 3), and advanced groups (Groups 4 and 5) were 95%, 79%, and 80%, respectively. However, when patients were grouped in a slightly different manner, 3 distinct prognostic groups were clearly identified: early (Groups 0 and 1), with a 5-year OS rate of 95%; intermediate (Groups 2, 3, and 4), with a 5-year OS rate of 81%; and advanced (Group 5), with a 5-year OS rate of 66%. The difference between the early and intermediate groups was significant at a P value of .0001, but the difference between the intermediate and advanced groups was not found to be significant (P ¼ .1).The same calculation was performed for the 5-year PFS, but we were unable to identify 3 distinct prognostic groups, even when grouping the patients as shown above.We conclude that the PSS did not perform as well in our series as it did in the original study. This finding illustrates anew the difficulties in developing reproducible prognostic systems in the setting of Hodgkin lymphoma.

Prevalence of human papillomavirus and cervical intraepithelial neoplasia in China: A pooled analysis of 17 population‐based studies

“…7 HR-HPV prevalence has been found to correlate well with cervical cancer risk in corresponding populations, particularly in middle age women. 8,9 In addition, the positive correlation between HPV prevalence and the age-standardized incidence of cervical cancer by subcontinent has been reported recently. 10 China's rapid industrialization and urbanization during the last three decades have coincided with an epidemic of sexually transmitted disease, 11 which may correlate with an increase in HR-HPV and CIN prevalence as well.…”