Prognostic Scores In Children

In the last years, three groups have reported results of trials from which prognostic scoring systems have been issued. The French Society of Pediatric Oncology reported that female gender, B symptoms, nodular scle-rosing histologic subtype, low hemoglobin (< 10.5 g/dL), and the presence of two of the following biologic factors—erythrocyte sedimentation rate more than 40 mm/1st hour, leukocytes more than 12 X 109/L, fibrinogen more than 5 g/L, a2-globulin less than 10 g/L, or albumin less than 35 g/L—significantly correlated (univariate analysis) with clinical outcome in 202 children with low-stage disease.33 Patients were found at high risk if they presented with hemoglobin less than 10.5 g/dL and nodular sclerosing histologic subtype and at least two of the other five biologic factors (prognostic scale derived from multivariate analysis).

Smith and coworkers have reported the results of a prognostic factor analysis based on three series of patients treated with combined-modality therapy at three institutions.34 Overall, the data of 328 pediatric patients was analyzed. Five factors were found of prognostic value on disease-free survival: male gender, stage IIB-IIIB-IV, bulky mediastinal disease, leukocytes more than 13.5 X 103/mm3, and hemoglobin less than 11 g/dL. Because the coefficients of all five factors ranged from 1.92 to 2.08, the score proposed was equal to the sum of the factors expressed by the patient. Patients were divided into four groups with significantly different prognosis. The disease-free survival rate was 94% in patients with zero to one factor present

(50% of all patients), 85% in those with two factors (23% of patients), 71% with three factors (16% of patients), and 49% with four or five factors (11% of patients). The overall survival rate ranged from 99% to 92% for patients with less than or equal to three factors present while it was only 72% for those with four to five factors.

The German-Austrian Pediatric Hodgkin's lymphoma Study Group reported the results of a retrospective study on factors that could predict for event-free surviva.35 Data from 552 children treated according to the HD-90 multicenter study was used. In this study, treatment was adapted to disease presentation, i.e., stage I-IIA, IIB-IIIA, and IIIB-IV. Significant univariate predictive factors were nodular sclerosing histologic subtype, B symptoms, number of involved regions and treatment. Using a multivariate regression model, only nodular sclerosing histologic subtype and B symptoms remained independent prognostic factors.

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