Adult Hodgkin's disease in Kerala.
BACKGROUND: Hodgkin's disease seen in the developing countries differs from that seen in developed countries. There are only a few reports from India regarding the epidemiologic and clinicopathologic features of Hodgkin's disease. METHODS: The records of 159 evaluable patients with Hodgkin's disease seen at the Regional Cancer Centre, Trivandrum, India, during the period 1983-1989 were reviewed for clinicoepidemiologic profile and survival analysis. The Kaplan-Meier product limit method was used to compute survival, and Cox proportional hazard regression analysis was used to study the factors affecting survival. RESULTS: The male-to-female ratio was 3.1:1. The mean age at presentation was 38 years in adults. Supradiaphragmatic presentation (44.7%) was more common, and mixed cellularity (50.3%) was the predominant histologic subtype. There were 9.4% patients with Stage I disease, 37.1% with Stage II, 33.4% with Stage III, and 20.1% with Stage IV disease. Of the patients, 57.9% were treated with chemotherapy, whereas 23.3% had radiation therapy alone, and 18.8% had a combination of radiation therapy and chemotherapy. Complete response was noted in 77.4% (n = 123) of patients, of whom 20.3% (n = 25) later experienced disease relapse. Second remission could be achieved in 8 of 25 patients with disease relapse. The overall 5-year survival rate was 55%. The stage-related survival rates were 89%, 69%, 53%, and 27% in Stage I-IV, respectively. On multivariate regression analysis, patient age and disease stage emerged as significant predictors of survival. CONCLUSION: Mixed cellularity was the most common histologic subtype. The inferior survival rate observed could be attributable to advanced stage of presentation, compromise on the drug and dose, and the lack of proper supportive measures. Patient age and disease stage were the important predictors of survival.