title: Improved survival time trends in Hodgkin's lymphoma.
abstract: There have been dramatic changes in the staging and treatment of Hodgkin's lymphoma (HL) over the past 30 years. We undertook this study to determine if a stage migration had occurred and also examined if treatment associated with later years has improved survival. Patients with stage I-IV HL between 1983 and 2011 were selected from the Surveillance, Epidemiology, and End Results database. Multivariable analysis (MVA) was performed using Cox proportional hazards modeling. The study cohort included 35,680 patients. The stage breakdown in 1983 according to A and B symptoms was follows: 18%, 21%, 12%, and 5% for stage IA, IIA, IIIA, and IVA disease, respectively, and 6%, 11%, 12%, and 15% for stage IB, IIB, IIIB, and IVB disease. The stage breakdown in 2011 according to A and B symptoms was follows: 9%, 29%, 10%, and 6% for stage IA, IIA, IIIA, and IVA disease, respectively, and 4%, 16%, 12%, and 13% for stage IB, IIB, IIIB, and IVB disease. The median follow-up for the entire cohort is 6.1 years. On MVA, the HR for mortality of patients diagnosed in 2006 was 0.60 (95% Confidence Interval (CI): 0.52-0.70) compared to 1983. For stage I and II patients diagnosed in 2006 the HR was 0.62 (95% CI: 0.44-0.87) and 0.40 (95% CI: 0.30-0.55), respectively, compared to patients diagnosed in 1983. For stage III and IV patients diagnosed in 2006 the HR was 0.72 (95% CI: 0.53-0.98) and 0.74 (95% CI: 0.56-0.99), respectively, compared to patients diagnosed in 1983. This is the first study to demonstrate a significant stage migration in early stage Hodgkin's lymphoma. Furthermore, these results demonstrate an improvement in survival over time for patients with Hodgkin's lymphoma which was particularly notable for those with early stage disease.
authors.affiliation: Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois, 60637.|Departments of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, 60637.
authors.forename: Matthew
authors.initials: M
authors.lastname: Koshy
authors.affiliation: Department of Radiation Oncology, University of Illinois at Chicago, Chicago, Illinois, 60637.
authors.forename: Andrew
authors.initials: A
authors.lastname: Fairchild
authors.affiliation: Departments of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois, 60637.
authors.forename: Christina H
authors.initials: CH
authors.lastname: Son
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Usama
authors.initials: U
authors.lastname: Mahmood
mesh_terms: D000328:Adult; D005260:Female; D006689:Hodgkin Disease / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009367:Neoplasm Staging; D011159:Population Surveillance; D016016:Proportional Hazards Models; D018426:SEER Program; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Lymphoma; stage migration; time trends