原发性中枢神经系统弥漫性大B细胞淋巴瘤30例临床病理特征及生存预后分析  

Clinicopathological characteristics and prognosis of primary diffuse large B cell lymphoma in central nervous system

作　　者：王烨[1] 马晓梅[1] 岳娜[1] 赵峰[1] 杨丽丽[1] 张银华[1] 梁莉萍[1] 

机构地区：[1]新疆医科大学附属肿瘤医院病理科,乌鲁木齐830000

出　　处：《诊断病理学杂志》2016年第10期736-741,共6页Chinese Journal of Diagnostic Pathology

基　　金：新疆医科大学校级科研创新项目(编号:XJC201318)

摘　　要：目的回顾性分析原发性中枢神经系统弥漫性大B细胞淋巴瘤的临床相关指标及组织病理学特点与预后的关系。方法收集有完整临床和随访资料、可进行系统性评估的中枢神经系统弥漫性大B细胞淋巴瘤病例30例,并应用免疫组化技术对全部病例进行CD10、CD20、bcl-6、MUM-1、Ki-67、CD34、bcl-2和CD3标记,根据Hans分类将其分为生发中心B细胞型(GCB型)和非生发中心B细胞型(non-GCB型)。采用Kaplan-Meier生存分析、COX回归多因素分析列出相关生存分析曲线,观察患者预后。结果单因素生存分析显示,患者发病年龄、体能状态评分(PS评分)、国际预后指数(IPI指数)、免疫表型及不同治疗方法与弥漫性大B细胞淋巴瘤患者的预后密切相关,差异显著(P<0.05);而患者性别、民族、Ann Arbor分期、是否存在B症状、发病部位、血清LDH、ESR、β2-微球蛋白水平、组织学分型、bcl-2和bcl-6阳性、Ki-67指数与预后无关。Cox模型多因素分析显示,仅免疫表型对患者的预后影响具有统计学意义,GCB型较non-GCB型患者预后好。结论原发性中枢神经系统弥漫性大B细胞淋巴瘤病情进展快、预后差;预后与患者发病年龄、PS评分、IPI评分、免疫表型及不同治疗方式有关,其中免疫表型是影响患者预后的独立危险因素,但bcl-6蛋白在肿瘤组织中的高表达与患者预后之间差异不显著。Objective To investigate the relationship between the prognosis and the clinical histopathological characteristics of primary diffuse large B cell lymphoma of the central nervous system. Methods 30 patients with pathologically confirmed primary diffuse large B cell lymphoma of the central nervous system were enrolled in Affiliated Tumor Hospital of Xinjiang Medical University. The En Vision two methods immunohistochemical staining was used to determine the expression of CD10,CD20,bcl-6,MUM-1,Ki-67,CD34,bcl-2 and CD3. Use Hans algorithm were classified into germinal center B cell（ GCB subtype） and non-germinal center B cell（ non-GCB subtype）. Kaplan-Meier analysis and COX regression model were used to carry out all the calculations. Results Kaplan-Meier survival analysis indicated age,ECOG score,IPI score,immunophenotype and treatment were prognostic factors of primary diffuse large B cell lymphoma of the central nervous system. Cox multiple factor regression analysis indicated that immunophenotype was the only independent prognostic factor of primary diffuse large B cell lymphoma of the central nervous system. Conclusion The prognosis of primary diffuse large B cell lymphoma of the central nervous system has related with the age,ECOG score,IPI score,immunophenotype and treatment. Immunophenotype is the only independent prognostic factor of primary diffuse large B cell lymphoma of the central nervous system. High expression of Bcl-6 protein of primary diffuse large B cell lymphoma of the central nervous system is of no statistically significant differences.

关 键 词：中枢神经系统 弥漫性大B细胞淋巴瘤 免疫学分型 生存分析 预后 

分 类 号：R733.4[医药卫生—肿瘤]