Prognostic factors for subdiaphragmatic involvement in clinical stage I-II supradiaphragmatic XXXX : a retrospective analysis of the GHSG.

@entity1 @entity978 @entity1625 @entity66
BACKGROUND: Staging laparotomy and splenectomy were routinely performed in @entity1 with early-stage @entity978 ( @entity978 ) qualifying for radiotherapy alone to determine the exact extent of disease. However, staging laparotomy is associated with a considerable number of side effects, warranting more sophisticated diagnostic procedures and new therapy strategies. We retrospectively analyzed @entity1 undergoing staging laparotomy to identify pretherapy risk factors predicting the probability of @entity1625 and to define high-risk groups that might benefit from staging laparotomy and subsequent stage-adjusted treatment. @entity1 AND METHODS: Between February 1988 and January 1993, 391 @entity1 with CS I-II supradiaphragmatic @entity978 underwent staging laparotomy and splenectomy according to the treatment policy of the German @entity978 Study Group (GHSG) for early stages of @entity978 . Univariate and multivariate analysis of pretherapeutic clinical characteristics were performed in an attempt to predict staging laparotomy results and to identify risk groups. RESULTS: Of the 391 @entity1 , 81 (21%) had @entity66 . Eighteen percent were upstaged to PS III and three percent to PS IV. By a multivariate model the following parameters were independent risk factors for positive surgical staging: left cervical involvement (P < 0.001), mediastinal involvement (P < 0.009), Karnofsky performance status (P < 0.004) and histology (P < 0.04). In our analysis gender (P < 0.08) and ESR (P < 0.06), often described as of high prognostic value, was not significant. The presence of systemic symptoms, number of involved areas and clinical stage were not associated with @entity1625 , as described in several former publications. To define high-risk groups, which comprise at least 15% of @entity1 of the cohort and have a risk of subdiaphragmatic involvement of > 35%, combinations of only two or three of the predictive factors were analyzed. With respect to these criteria the following subgroups of @entity1 were identified as having a high risk for @entity66 (> 35%): a) left cervical lymph node involvement and no mediastinal involvement (n = 98, observed risk 36%); b) no mediastinal involvement and MC/LD histology (n = 113, observed risk 40%). CONCLUSIONS: We conclude that initial clinical characteristics are predictive for occult abdominal involvement in early clinical stages of @entity978 . The impact of these risk factors on future therapeutical strategies have to be evaluated.
