Non-Hodgkin's lymphoma in northern Sweden. A retrospective analysis of morphologic diagnosis and stage in a material from the Swedish Cancer Registry.

Morphologic diagnosis and clinical stage were studied in a retrospective material of non-Hodgkin's lymphomas comprising 352 patients diagnosed 1978 until 1982 and reported to a regional cancer registry. Classification was made according to the original Kiel classification. Patients who could be classified as belonging to low- (46%) or high-grade (47%) malignancy groups (n = 337) were further studied. The median age was high, 65 years, which probably reflects the low degree of selection in a regional register material compared to most hospital register-based materials. The proportion of stage I cases was rather high, in low-grade lymphomas 24%, and in high-grade 39%, which can be attributed to incomplete staging procedures in old patients. The aim of the study was to illustrate the distribution according to morphologic subclasses and clinical features in a material with a low degree of patient selection.

Hodgkin's disease in northern Sweden 1971-1981. II. A retrospective analysis of prognostic factors.

Factors relevant for prognosis were retrospectively studied in a series of 133 morphologically reviewed patients with Hodgkin's disease collected between 1971 and 1981. For the whole material complete remission rate was 74% and 5-year survival was 62%. These seemingly rather poor results could be explained by a high mean age (48 years) in this relatively unselected material, in combination with a very unfavourable outcome for the elderly patients. In a multivariate analysis of prognostic factors age of the patient turned out to be the only independent factor with a significant bearing on the prognosis.

Hodgkin's disease in northern Sweden 1971-1981. I. A histopathological reevaluation of 223 cases.

A histopathological reexamination was made of diagnostic material in 223 patients with Hodgkin's disease (HD) collected between 1971 and 1981. The diagnosis of HD was considered to be incorrect in 90 cases (40%). Change of diagnosis to non-Hodgkin's lymphoma was made in 56 cases, of which 23 were high-grade and 26 were low-grade lymphomas (7 not determined), and to angioimmunoblastic lymphadenopathy in 10 cases. These discrepancies were considered to be due mainly to progress in the understanding and classification of malignant lymphomas, which stresses the importance of review of histologic material in retrospective studies on Hodgkin's disease.

Hodgkin's disease in northern Sweden 1971-1981. III. The clinical and prognostic impact of age.

A retrospective material of 133 patients with Hodgkin's disease treated between 1971 and 1981 was analysed. In part II of this study it was shown that the prognosis was closely associated with age of the patient. In this part some clinical factors, including therapy, were compared between 66 patients less than 50 years of age and 67 patients 50 years or more. The groups differed mainly in the outcome of primary chemotherapy. Older patients with Hodgkin's disease were particularly vulnerable to chemotherapy, probably as an effect of the disease itself.

Non-Hodgkin lymphoma. Multivariate analysis of prognostic factors including fraction of S-phase cells.

In a material of 80 patients with non-Hodgkin lymphoma a multivariate analysis was carried out taking the following variables into account: Age, clinical stage, B-symptoms, morphologic diagnosis and fraction of S-phase cells in the tumour determined by flow cytometry. Clinical stage, proportion of cells in the S-phase, and age of the patient were significant independent prognostic factors. Morphologic malignancy grade and B-symptoms were not significant parameters in this analysis. It was concluded that DNA analysis with determination of the fraction of S-phase cells is a valuable complement to morphology in the evaluation of patients with non-Hodgkin lymphoma. In combination with the clinical stage it gives very good discrimination into groups with different prognoses.

Prognostic significance of DNA-analysis by flow cytometry in non-Hodgkin's lymphoma.

DNA analysis by flow cytometry was performed on lymph node cells obtained from 65 untreated patients with non-Hodgkin's lymphoma. According to the Kiel classification 41 cases were of low grade malignancy and 24 cases belonged to the high grade malignancy group. 47 out of 61 evaluable cases were diploid/near-diploid, 12 were aneuploid and 2 cases showed polyploidy. No difference in survival was found between diploid/near-diploid and aneuploid cases. The percentage of S-phase cells was found to be a valuable prognostic parameter. Using a cut point at 4 per cent S-phase cells between low and high S-phase lymphomas a highly significant difference in survival was demonstrated (p = 0.0004). The actuarial survival up to 3 years was about 77 per cent for lymphomas with less than 4 per cent S-phase cells to be compared with 20 per cent for patients with high S-phase (greater than or equal to 4 per cent) lymphomas. Subdivision according to the percentage of S-phase cells seemed to be a better prognostic predictor than morphologic subclassification.

The diagnostic value of fasting serum total bile acid concentration in patients with suspected liver disease. A prospective, consecutive study.

To assess the diagnostic value of fasting serum total bile acids (STBA) in liver disease, STBA together with serum bilirubin (BIL), serum alkaline phosphatase (AP), and serum aspartate aminotransferase (ASAT) were measured in 66 consecutive patients who had a liver biopsy. Twenty-four of the patients who had normal liver histology all had normal STBA values (less than 8 mumol/l). In the remaining 42 patients with abnormal liver histology STBA values were elevated in 21, corresponding to a sensitivity of 0.50. The same figures for BIL, AP, and ASAT were 0.52, 0.76, and 0.79, respectively. The predictive values of elevated (PVpos) and normal (PVneg) STBA for disclosing or excluding liver disease, respectively, were not better than the figures for BIL, AP, and ASAT. None of the tests were suited for distinguishing among various liver diseases. It is concluded that STBA had no diagnostic advantage as compared with the commonly used liver function tests BIL, AP, and ASAT.