title: Prognostic significance of Bcl-2, tumor-associated macrophages, and total neoplastic and inflammatory lymph node involvement in advanced stage classical Hodgkin's lymphoma.
abstract: BACKGROUND
  Although Hodgkin's lymphoma (HL) is a curable cancer, current treatment strategies based on risk stratification and response modulation are not precise enough. The predictive power of biological and morphological parameters is controversial, with prognostic models not reaching wide acceptance.
  
  
  METHODS
  We analyzed the prognostic relevance of 8 parameters in 85 advanced stage classical HL patients, in order to determine whether tissue-based variables could add prognostic value to standard clinical parameters, thus contributing to better risk stratification at presentation.
  
  
  RESULTS
  Univariate analysis confirmed 5 indicators of shorter overall survival (OS): Bcl-2 overexpression; increased CD68+ tumor-associated macrophages (TAM); international prognostic score (IPS) > 2; bulky disease; and total lymph node involvement (TLNI) with regard to neoplastic and inflammatory cells. Apart from TLNI, these parameters influenced lower event-free survival (EFS). Multivariate analysis identified 5 independent factors for OS: Bcl-2 overexpression; increased CD68+ TAM; TLNI; IPS > 2; and bulky disease. Increased CD68+ TAM, IPS > 2, and bulky disease affected the EFS. Utilizing the cumulative score of unfavorable prognostic factors for OS, we designed a prognostic model stratifying patients into 4 risk groups (with 0-1, 2, 3, or 4-5 factors), each with progressively reduced OS (p < 0.001).
  
  
  CONCLUSIONS
  Our findings support the combination of tissue-based variables with clinical parameters at diagnosis, identifying patients who are at higher risk of poor outcome.
authors.affiliation: Clinic for Hematology, Clinical Center of Serbia, Belgrade, Serbia. ljubajak@yahoo.com
authors.forename: Ljubomir R
authors.initials: LR
authors.lastname: Jakovic
authors.forename: Biljana S
authors.initials: BS
authors.lastname: Mihaljevic
authors.forename: Maja D Perunicic
authors.initials: MD
authors.lastname: Jovanovic
authors.forename: Andrija D
authors.initials: AD
authors.lastname: Bogdanovic
authors.forename: Bosko M
authors.initials: BM
authors.lastname: Andjelic
authors.forename: Vladimir Z
authors.initials: VZ
authors.lastname: Bumbasirevic
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis*; D015897:Comorbidity; D005260:Female; D006689:Hodgkin Disease / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008205:Lymphangitis / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology*; D008207:Lymphatic Metastasis; D008264:Macrophages / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D019253:Proto-Oncogene Proteins c-bcl-2 / Q000032:analysis*; D012307:Risk Factors; D055771:Serbia / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D019253:Proto-Oncogene Proteins c-bcl-2