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Analysis of Competing Risks of Causes of Death and their Variation Over Different Time Periods in Hodgkin's Disease

Authors' Affiliations: ¹ Medical Oncology, ² Biostatistics, ³ Internal Medicine, and ⁴ Pathology, University Hospital Puerta de Hierro, Madrid, Spain

Requests for reprints: Mariano Provencio, Servicio de Oncología Médica, Hospital Puerta de Hierro, San Martín de Porres 4, 28035 Madrid, Spain. Phone: 34-91344-5148; Fax: 34-91344-5190; E-mail: mprovenciop{at}yahoo.es.

Purpose: Hodgkin's disease is considered a model of curable illness. However, long-term studies show excessive mortality in relation to the general population. We studied the various causes of death by use of competing risks and their evolution over the years.

Experimental Design: All patients diagnosed with Hodgkin's disease at our institution between 1967 and 2003 were included. The competing risks of causes of death and their vital situation were examined in three time periods: cohort A with patients treated before 1980, cohort B with patients treated from 1981 to 1986, and cohort C with patients treated from 1986 onwards.

Results: We studied 534 patients, with a median follow-up time of 9.1 years for the whole cohort. The 5-year, 15-year, and 20-year Kaplan-Meier survival estimates for all patients were 81%, 72%, and 65%, respectively. At the close of the study, 337 (63.1%) were alive and 170 (31.8%) patients had died. The most common cause of death was the progression of Hodgkin's disease, followed by deaths due to a second tumor. Survival was significantly worse in the first period than in the other two (P < 0.001), and in the three periods, the main cause of death was tumor progression.

Conclusions: The progression of Hodgkin's disease is the main cause of death. Over time, a reduction in death related to infection and the acute toxicity of treatment was seen. A lot of patients still die for reasons linked to delayed side effects of radiotherapy, such as second tumors and heart disease, which is important to plan preventive activities and clinical research.