title: Epstein-Barr virus and survival after Hodgkin disease in a population-based series of women.
abstract: BACKGROUND
  Epstein-Barr virus (EBV) positive Hodgkin disease (HD), as defined by the presence of EBV genes or gene products in the malignant cells, differs epidemiologically from EBV negative HD. However, survival patterns for EBV-defined HD have not been well studied. To determine if EBV status influenced survival time after HD, the authors investigated a large, population-based series of female patients.
  
  
  METHODS
  For 311 female patients living in the Greater San Francisco Bay Area who were aged 19-79 years with HD diagnosed between mid-1988 and 1994, histopathologically rereviewed archived biopsy specimens were assayed for EBV with immunohistochemistry and in situ hybridization. The 53 subjects with EBV positive and the 258 with EBV negative HD were observed for vital status through 1998; overall survival was analyzed with Kaplan-Meier and Cox proportional hazards regression methods.
  
  
  RESULTS
  Epstein-Barr virus positive HD patients were older, received diagnosis at a later stage, and were less likely to have nodular sclerosis histology than EBV negative patients. Deaths were reported for 21 (40%) EBV positive and 37 (14%) EBV negative patients. No survival differences were observed between EBV positive and negative women aged 19-44 years, but survival was significantly poorer in women aged 45-79 years with EBV positive HD. Regression analysis confirmed this strong negative effect of EBV positive status on survival (hazard ratio for death, 3.0; 95% confidence interval, 1.5-6.2) as unrelated to age, stage at diagnosis, or tumor histology.
  
  
  CONCLUSIONS
  This study found a marked survival disadvantage for EBV positive HD in older but not young adult women. These findings suggest influences of both EBV status and age on HD survival, as well as pathogenesis.
authors: Northern California Cancer Center, Union City, California 94587, USA. tclarke@nccc.org
authors: C A
authors: CA
authors: Clarke
authors: S L
authors: SL
authors: Glaser
authors: R F
authors: RF
authors: Dorfman
authors: R
authors: R
authors: Mann
authors: J A
authors: JA
authors: DiGiuseppe
authors: A W
authors: AW
authors: Prehn
authors: R F
authors: RF
authors: Ambinder
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D016021:Epidemiologic Studies; D020031:Epstein-Barr Virus Infections / Q000150:complications*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D006689:Hodgkin Disease / Q000401:mortality / Q000473:pathology / Q000821:virology*; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis