Q24. According to the European Organization for the Research and Treatment of Cancer (EORTC) classification which is wrong about unfavorable characteristics for stage I and II Hodgkin lymphoma?¶

(A) Age >= 50
(B) ESR > 50 in asymptomatic patient, ESR > 30 in patients with B symptom
(C) Maximal width of mass/maximal intrathoracic width (MTR)> 0.5
(D) Nodal site > 3

點此顯示正解

(C) Maximal width of mass/maximal intrathoracic width (MTR)> 0.5

詳解¶

Answer¶

Option (C) is the incorrect statement because the EORTC uses a mediastinal-to-thoracic ratio (MTR) threshold of >0.35, not >0.5, to define unfavorable characteristics in early-stage Hodgkin lymphoma⁴[^7][8][^9].

The NCCN guidelines provide a helpful comparison table showing the differences between major risk stratification systems:

Why (C) is Wrong¶

The EORTC defines bulky mediastinal disease as a mediastinal/thoracic ratio >0.35 (measured as the maximum width of mediastinal mass divided by the intrathoracic diameter at T5-6 on chest radiograph)⁴[^7][8][^9]. The threshold of 0.5 stated in option (C) is incorrect and would miss a substantial proportion of patients with unfavorable disease. For comparison, the German Hodgkin Study Group (GHSG) uses an even lower threshold of >0.33 for their mediastinal mass ratio[^7].

Why the Other Options Are Correct¶

(A) Age ≥50 is a true EORTC unfavorable factor. The EORTC specifically defines age ≥50 years (or "older than 49 years") as an unfavorable prognostic factor for stage I-II disease¹²⁴[^7][9][^10].

(B) ESR >50 in asymptomatic patients, ESR >30 in patients with B symptoms is a true EORTC unfavorable factor. The EORTC criteria specify ESR >50 mm/h in asymptomatic (A symptom) patients or ESR >30 mm/h in patients with B symptoms as unfavorable¹²⁴[^7][9][^10].

(D) Nodal site >3 is a true EORTC unfavorable factor. The EORTC defines involvement of ≥4 nodal areas (i.e., more than 3) as an unfavorable characteristic¹²⁴[^7][9][^10]. This differs from the GHSG, which uses ≥3 nodal regions as their threshold[^7].

詳解 · 中文翻譯¶

答案¶

選項 (C) 是不正確的陳述，因為 EORTC 使用縱隔對胸腔比率 (MTR) 閾值 >0.35（而非 >0.5）來定義早期霍奇金淋巴瘤的不利特徵⁴[^7][8][^9]。

為何 (C) 錯誤¶

EORTC 定義為 mediastinal/thoracic 比率 >0.35 的大塊縱隔疾病（測定為胸部 X 線 T5-6 處縱隔病塊的最大寬度除以胸腔內直徑）⁴[^7][8][^9]。選項 (C) 中陳述的 0.5 閾值是不正確的，將遺漏大量具有不利疾病的患者。相比之下，德國霍奇金研究組（GHSG）對其縱隔腫塊比率使用更低的 >0.33 閾值[^7]。

其他選項為何正確¶

(A) 年齡 ≥50 是真實的 EORTC 不利因素。EORTC 特別定義年齡 ≥50 歲（或「超過 49 歲」）為第 I-II 期疾病的不利預後因素¹²⁴[^7][9][^10]。

(B) 無症狀患者 ESR >50，有 B 症狀患者 ESR >30 是真實的 EORTC 不利因素。EORTC 標準指定無症狀（A 症狀）患者 ESR >50 mm/h 或有 B 症狀患者 ESR >30 mm/h 為不利¹²⁴[^7][9][^10]。

(D) 結點位點 >3 是真實的 EORTC 不利因素。EORTC 定義 ≥4 個結點區域（即超過 3）的浸潤為不利特徵¹²⁴[^7][9][^10]。這不同於使用 ≥3 個結點區域作為其閾值的 GHSG[^7]。

參考文獻 (AMA)¶

Yung L, Linch D. Hodgkin's Lymphoma. Lancet (London, England). 2003;361(9361):943-51. doi:10.1016/S0140-6736(03)12777-8. PMID:12648984. ↩↩↩↩↩↩
National Comprehensive Cancer Network. Hodgkin Lymphoma. https://www.nccn.org/professionals/physician_gls/pdf/hodgkins.pdf#page=11. ↩↩↩↩↩↩
Townsend W, Linch D. Hodgkin's Lymphoma in Adults. Lancet (London, England). 2012;380(9844):836-47. doi:10.1016/S0140-6736(12)60035-X. PMID:22835602. ↩
Goldkuhle M, Kreuzberger N, von Tresckow B, et al. Chemotherapy Alone Versus Chemotherapy Plus Radiotherapy for Adults With Early-Stage Hodgkin's Lymphoma. The Cochrane Database of Systematic Reviews. 2024;12:CD007110. doi:10.1002/14651858.CD007110.pub4. PMID:39620432. ↩↩↩↩↩↩↩↩↩↩
Brice P, de Kerviler E, Friedberg JW. Classical Hodgkin Lymphoma. Lancet (London, England). 2021;398(10310):1518-1527. doi:10.1016/S0140-6736(20)32207-8. PMID:33493434. ↩