免疫化疗时代弥漫大B细胞淋巴瘤免疫学亚型的预后意义  

Prognostic value of immunophenotype in patients with diffuse large B-cell lymphoma in the immune chemotherapy era

作　　者：李燕[1] 刘虹[1] 木合塔拜尔[1] 安利[1] 王晓敏[1] 

机构地区：[1]新疆维吾尔自治区人民医院血液科,乌鲁木齐830001

出　　处：《肿瘤研究与临床》2015年第11期748-753,共6页Cancer Research and Clinic

基　　金：国家自然科学基金（81460033）

摘　　要：目的探讨弥漫大B细胞淋巴瘤（DLBCL）患者免疫学亚型在预后评价中的意义，以及利妥昔单抗对免疫组织化学标志预后意义的影响。方法回顾性分析186例初治DLBCL患者的病例资料，按照国际预后指数分为相对高危组及相对低危组，两组分别根据治疗方案分为化疗组（CHOP）及免疫化疗组（R—CHOP），应用免疫组织化学方法及Hans分型对各组患者进行免疫分型，采用Log．rank检验比较免疫学亚型在不同预后分组及不同治疗方案DLBCL患者中的预后意义。结果186例DLBCL患者中，化疗组中生发中心型（GCB型）5年总生存（OS）率明显高于非生发中心型（non—GCB型）（58．82％比32．00％，X2=8．482，P=0．004），而免疫化疗组中GCB型与non-GCB型5年0s率差异无统计学意义（72．97％比61．54％，X2=2．694，P=0．101）。免疫化疗组中non—GCB型的5年OS率较化疗组升高，差异有统计学意义（61．54％比32．00％，x2=7．385，P=0．007）。低危组107例中，化疗组及免疫化疗组中GCB型和nod—GCB型5年OS率差异均无统计学意义（均P〉0．05），GCB型及non—GCB型中化疗组与免疫化疗组5年OS率差异均无统计学意义（均P〉0．05）。高危组79例中，化疗组中GCB型和non-GCB型的5年0s率差异有统计学意义（40．00％比22．72％，X2=3．978，P=O．045）；免疫化疗组中GCB型和non—GCB型的5年OS率差异无统计学意义（62．50％比42.31％．X2=2．072．P=0．150）。结论采用免疫组织化学方法将初治DLBCL分为两种免疫学亚型，对于早期判断预后、指导治疗具有一定的意义。在利妥昔单抗时代，免疫组织化学分型的预后预测价值可能较以往有所降低。利妥昔单抗可显著提高non-GCB型DLBCL患者的疗效，但是对GCB型患者生存期的影响还需进一步探讨。Objective To study the prognostic value of immunophenotypes in the patients with diffuse large B-cell lympboma （DLBCL） and its prognostic significance of immunohistochemical markers for rituximab. Methods The data of 186 initial DLBCL patients were retrospectively analyzed. According to the international prognostic index, all patients were divided into relatively high-risk group and relatively low-risk groups, and the patients in both groups were divided into chemotherapy （CHOP） group and immune chemotherapy （R-CHOP） group, respectively, lmmunohistochemical method and Hans typing method were applied to immune classification in all of groups. The prognostic significances of the immunological subtypes in different prognosis group were compared by Log-rank test. Results The 5-year OS rate of the GCB subtype patients in the CHOP group was significantly higher than that of the non-GCB subtype （58.82 % vs 32.00 %, X 2 = 8.482, P = 0.004）, while that was no significant difference between GCB and non-GCB subtypes patients in the R-CHOP group （72.97 % vs 61.54 %, X2 = 2.694, P = 0.101）. Further analysis results showed that non-GCB subtype patients treated with R-CHOP had significantly higher 5-year OS rate than those treated with CHOP （61.54 % vs 32.00 %, X2 = 7.385, P = 0.007）. In the 107 cases of low risk group, there was no significant difference in 5-year OS rate between GCB and non-GCB subtype patients in the CHOP group or in the R-CHOP group （all P 〉 0.05）, and there was no significant difference in 5-year OS rates between the CHOP and R-CHOP groups in the GCB group or in the non-GCB group （all P 〉 0.05）. In the 79 cases of high risk group, the 5-year OS rate in the GCB subtype group was significantly higher than that in the non-GCB subtype in the CHOP group （40.00 % vs 22.72 %, X2 = 3.978, P = 0.045）, while there was no significant difference in 5-year OS rates between GCB and non-GCB subtype patients in the R-CHOP group （62.50 % vs 42.31%, X 2 = 2.072, P = 0.150）. Conclu

关 键 词：淋巴瘤 大B细胞 弥漫型 免疫亚型 预后 利妥昔单抗 

分 类 号：R733.1[医药卫生—肿瘤]