{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T11:46:02Z","timestamp":1785843962672,"version":"3.56.0"},"reference-count":24,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: The prognostic significance of extranodal disease in classical Hodgkin lymphoma remains incompletely defined. Although contemporary models such as the Advanced Hodgkin International Prognostic Index (A-HIPI) improve systemic risk stratification, it remains unclear whether outcomes are more closely associated with specific extranodal organ involvement or with the overall burden of extranodal dissemination. Methods: This retrospective single-center study included 89 patients with predominantly advanced-stage classical Hodgkin lymphoma, including a minority of high-risk stage II bulky cases, and documented extranodal involvement at diagnosis. Extranodal disease was evaluated according to both organ-specific involvement and extranodal organ burden (EOB), defined as single extranodal organ involvement (single EO) versus involvement of two or more extranodal organs (\u22652 EO). Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan\u2013Meier analysis and Cox proportional hazard models. Risk stratification was examined using both the International Prognostic Score (IPS) and A-HIPI. Results: Patients with \u22652 EO had significantly inferior OS compared with those with single EO involvement (5-year OS, 66.8% vs. 96.7%; log-rank p = 0.018), whereas the difference in PFS did not reach statistical significance (5-year PFS, 49.6% vs. 73.5%; log-rank p = 0.108). A-HIPI-based stratification significantly discriminated OS (5-year OS, 92.2% vs. 78.2%; p = 0.001) and showed borderline discrimination for PFS (5-year PFS, 71.5% vs. 57.2%; p = 0.053). In the combined analysis, patients with high A-HIPI risk and \u22652 EO had the poorest outcomes, with a 5-year PFS of 34.1% and a 5-year OS of 25.0%. In a parsimonious multivariable Cox model including EOB and A-HIPI-predicted 5-year risk as a continuous variable, \u22652 EO remained associated with inferior OS (HR 3.83, 95% CI 1.34\u201310.97; p = 0.013), while its association with PFS was adverse but not statistically significant (HR 1.83, 95% CI 0.86\u20133.88; p = 0.114). Organ-specific extranodal involvement showed limited and inconsistent associations with survival across A-HIPI- and IPS-defined subgroups. Conclusions: In this retrospective single-center cohort, involvement of multiple extranodal organs was associated with inferior OS after adjustment for continuous A-HIPI-predicted risk, whereas its association with PFS did not reach statistical significance. Individual extranodal sites showed no consistent prognostic associations. These exploratory and hypothesis-generating findings suggest that quantitative assessment of extranodal organ burden may complement existing clinical risk measures; however, confirmation in larger, contemporary, externally validated cohorts is required before clinical application.<\/jats:p>","DOI":"10.3390\/jcm15156067","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T10:38:08Z","timestamp":1785839888000},"page":"6067","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Impact of Extranodal Organ Burden in Classical Hodgkin Lymphoma with Extranodal Involvement: A Retrospective Cohort Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3577-6330","authenticated-orcid":false,"given":"Salih Serta\u00e7","family":"Durusoy","sequence":"first","affiliation":[{"name":"Department of Hematology, Ali Osman S\u00f6nmez Oncology Hospital, Bursa 16040, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2690-8581","authenticated-orcid":false,"given":"Tayfur","family":"Topta\u015f","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Marmara University, \u0130stanbul 34899, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7942-3994","authenticated-orcid":false,"given":"Dervi\u015f Murat","family":"Akkurd","sequence":"additional","affiliation":[{"name":"Department of Hematology, Mersin City Training and Research Hospital, Mersin 33110, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9150-924X","authenticated-orcid":false,"given":"Ali","family":"Tekba\u015f","sequence":"additional","affiliation":[{"name":"Department of Hematology, Gaziantep City Hospital, Gaziantep 27010, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5796-6066","authenticated-orcid":false,"given":"Abdi \u0130brahim Halil","family":"S\u00f6nmez","sequence":"additional","affiliation":[{"name":"Department of Hematology, Kilis Prof. Dr. Alaeddin Yava\u015f\u00e7a State Hospital, Kilis 79090, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-4506-1177","authenticated-orcid":false,"given":"Handan Haydaro\u011flu","family":"\u015eahin","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9869-8181","authenticated-orcid":false,"given":"Vahap","family":"Okan","sequence":"additional","affiliation":[{"name":"Department of Hematology, Faculty of Medicine, Gaziantep University, Gaziantep 27310, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1002\/ajh.26717","article-title":"Hodgkin lymphoma: 2023 update on diagnosis, risk-stratification, and management","volume":"97","author":"Ansell","year":"2022","journal-title":"Am. 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