Comparison of the long-term mortality in Hodgkin's disease patients with that of the general population

Background: Although Hodgkin's disease can be treated successfully, its long-term survival rate has yet to be definitely established. We compared the long-term mortality rate of patients diagnosed as having Hodgkin's disease with that of the general population. Patients and methods: We studied a retrospective cohort of 477 patients who received pathology-confirmed diagnoses of Hodgkin's disease between 1967 and 1993 and were treated with combined chemotherapy or radiotherapy with follow-up from the day of diagnosis. Standardised mortality ratios were computed with reference rates taken from the Spanish population. Results: The follow-up was complete for 427 (89.5%) of the patients. The median follow-up time was 8 years, 133 patients (28%) died and the median survival time was 21 years. The overall survival rates were 80% at 5 years, 70% at 10 years, and 64% at 15 years after diagnosis. The standardised mortality ratios were 10.8 (95% confidence interval: 9.0-12.8, P < 0.0001) overall, 5.5 in patients in favourable stages (IA, IIA), and 15.2 in those with unfavourable stages (IB, IIB, III, IV). There was a decreasing trend in mortality by calendar period (standardised mortality ratios for 1967-1975, 1976-1974 and 1985-1993: 16.8, 10.3 and 5.1, respectively). Higher mortality was observed in all periods of follow-up after diagnosis, even after 20 years. Conclusions: Despite the improvements in treatment, mortality in Hodgkin's disease remains higher than in the general population in all disease stages, even 20 years after diagnosis.