CD68、cyclin D1蛋白和bcl-6基因在弥漫性大B细胞淋巴瘤中的表达及意义  

Expression of CD68, cyclin D1 and rearrangement of bcl-6 gene are adverse prognostic factors in diffuse large B-cell lymphoma

作　　者：梁晓杰[1] 王晋芬[1] 白纬[1] 孙瑞芳[1] 

机构地区：[1]山西省肿瘤医院病理科,太原030013

出　　处：《中华病理学杂志》2015年第8期559-564,共6页Chinese Journal of Pathology

基　　金：山西省自然科学基金（2014011039-1）;山西省回国留学人员科研资助项目（[2014]9）

摘　　要：目的探讨CD68、cyclin D1蛋白表达及bcl-6基因重排对弥漫性大B细胞淋巴瘤（DLBCL）预后的影响。方法选取105例有详细随访资料的DLBCL患者石蜡样本，应用免疫组织化学EnVision法进行CD3、CDl0、CD20、CD68、cyclinD1、bcl-6、MUM1、SOX-11免疫标记，根据Han’s分类方法将DLBCL分为生发中心B细胞型（GCB型）和非生发中心B细胞型（non．GCB型）；应用荧光原位杂交（FISH）技术检测bcl-6基因重排。应用统计软件分析CD68蛋白、cyclin D1蛋白、bcl-6基因、化疗方案及各临床因素与生存期之间的关系。分别以GCB型、non-GCB型免疫表型和CHOP、R-CHOP化疗方案分组，比较疗效差异。结果105例患者中GCB型19例（18．1％），non-GCB型86例（81．9％），CD68高表达18例（17．1％），cyclin D1高表达36例（34．3％）。bcl-6基因重排21例（21．9％），CD68高表达、cyclinD1高表达与bcl-6基因重排三者之间无相关关系（P〉0．05）；单因素分析发现年龄≤60岁、临床分期I～Ⅱ期、IPI评分0～2分、乳酸脱氢酶（LDH）〈245 IU／L、GCB型、R-CHOP治疗方案患者的预后较好（P〈0．05），性别、原发部位与预后无相关关系（P〉0．05）。CD68、cyclin D1高表达、bcl-6重排者预后不良（P〈0．05）；分层结果显示GCB型或non-GCB型CD68高表达对比同种免疫表型组都具有较差的预后，non-GCB型时cyclinD1高表达和bel．6基因重排的预后不佳（P〈0．01，P=0．02）；治疗方案分层分析得出，在使用CHOP方案治疗时，CD68、eyclinD1高表达预后较差（P〈0．05），R-CHOP方案时，CD68、cyclinD1高表达与总生存期的差异无统计学意义（P=0．428和0．168）。多因素COX模型分析显示CD68高表达（P=0．026）、cyelinD1高表达（P=0．003）及LDH高水平（P=0．005）为各自独立的预后不良因素。结论CD68、cyclinD1高表达和bel-6基因重排提示预后差，CD68、cyclinD1蛋白和bel-6基因可以�Objective To study expression of CD68, cyclin D1 protein and rearrangement of bcl-6 gene impact on the prognosis of diffuse large B-cell lymphoma （DLBCL）. Methods Gets paraffin samples of the 105 cases DLBCL with the detailed follow-up information, and were studied by using immunohistoehemical EnVision method for CD3, CD10, CD20, CD68, cyelin D1, bel-6, MUM 1, SOX-11 immunolabeling. The DLBCL were classified into germinal center B cell-like （GCB） subtypes and non- germinal center B cell-like （non-GCB） subtypes according to Hans＇algorithm. Application of fluorescence in situ hybridization （FISH） technique to detect the bcl-6 gene rearrangement. The relationship between CD68, cyelin D1 protein, the bel-6 gene and the curative effect of chemotherapy and survival was analyzed using statistical software. Respectively by GCB type, non-GCB type immune phenotype and CHOP, R-CHOP chemotherapy group, compare the curative effects. Results 105 patients had GCB 19 cases （ 18.1% ） , non-GCB 86 cases （81.9%）, CD68 expression was 18 cases （ 17. 1% ） , cyclin D1 high expression 36 cases （34. 3% ）, bcl-6 gene rearrangement in 21 cases （21.9%）, there is no correlation among the three （P 〉0. 05）. One-way analysis of variance showed that age ≤60 years, clinical stage I - Ⅱ, IPI score 0 to 2 points, LDH （U/L） 〈 245 IU/L, GCB subtypes, R-CHOP therapy, the prognosis of patients with better （P 〈0. 05）, But gender, primary site no correlation with prognosis （P 〉0. 05）. CD68,cyclin D1 high expression, bcl-6 rearrangement had poor prognosis （ P 〈 0. 05 ）. Stratification analysis results show GCB-type or non-GCB type with high expression of CD68 contrast alloimmune phenotype groups had a poor prognosis,non-GCB type with high expression of cyclin D1 and rearrangement of bcl-6 gene had a poor prognosis（P 〈 0. 001, P = 0. 02）. Treatment scheme of layered display, the CHOP treatment, significantly correlated with overall survival with high expression of CD68, cyclin D1

关 键 词：淋巴瘤 大B-细胞 弥漫性 细胞周期蛋白D1 基因 BCL-6 预后 

分 类 号：R733.1[医药卫生—肿瘤]