DLBCL的临床病理特征及影响预后的相关因素分析  

Clinicopathological Features and Prognostic Factors of DLBCL

作　　者：林剑扬[1] 郑艳彬[1] 何鸿鸣[1] 王杰松[1] 杨瑜[1] 陈道光[1] 陈英[1] LIN Jian-Yang;ZHENG Yan-Bin;HE Hong-Ming;WANG Jie-Song;YANG Yu;CHEN Dao-Guang;CHEN Ying(Department of Lymphoma and Head and Neck Cancer, Fujian Tumor Hospital, Affiliated Cancer Hospital of Fujian Medical University Fuzhou 350014, Fujian Province, China)

机构地区：[1]福建省肿瘤医院淋巴瘤及头颈部肿瘤内科,福建医科大学附属肿瘤医院,福建福州350014

出　　处：《中国实验血液学杂志》2018年第3期779-783,共5页Journal of Experimental Hematology

基　　金：国家临床重点专科建设项目资助(国卫办医函[2013]544号)

摘　　要：目的:分析弥漫大B细胞淋巴瘤(DLBCL)的临床病理特征及影响预后的相关因素。方法:对福建省肿瘤医院均获随访的94例DLBCL患者,采用免疫组化法检测BCL-2、BCL-6、MYC、CD10及MUM-1蛋白的表达,用间期荧光原位杂交法分析MYC和BCL-2基因的异常;探究DLBCL患者的临床病理特征及影响预后的相关因素。结果:94例患者中,BCL-2、BCL-6、MYC、CD10及MUM-1蛋白阳性率分别为75.53%(71/94)、58.51%(55/94)、52.13%(49/94)、15.96%(15/94)、34.04%(32/94)。MYC基因异常检出率为20.93%(9/43),BCL-2基因异常检出率为44.00%(22/50),2种基因异常均为多拷贝;MYC与BCL-2基因同时异常者2例(2.13%)。94例患者3年中位生存时间为21.79(2-36)个月,1、3年总生存率分别为82.98%和64.89%。单因素分析结果发现,ECOG评分≥2、国际预后指数(IPI)分级增加、BCL-6蛋白阳性表达、MYC和及BCL-2基因同时异常均是影响预后的危险因素(P<0.05)。COX风险模型回归分析结果发现,IPI分级、ECOG评分及治疗方法均是影响患者预后效果的独立因素(P<0.05)。结论:IPI分级、ECOG评分及治疗方法对DLBCL患者预后效果的影响较大,化疗联合放疗或手术的治疗方法可以明显提高患者的预后效果。Objective： To analyze the clinicopathological features and prognostic factors of patients with diffuse large B-cell lymphoma（ DLBCL）.Methods： Ninety-four cases of DLBCL follow ed up were selected in Fujian Tumor Hospital.The immunohistochemistry method was used to detect the protein expressions of BCL-2 BCL-6,MYC,CD10 and MUM-1,the gene abnormalities of MYC and BCL-2 were analyzed by fluorescence in situ hybridization,and the clinical pathological features and the related factors affecting prognosis in the patients with DLBCL were analyzed.Results：The protein positive rates of BCL-2,BCL-6,MYC,CD10 and MUM-1 in 94 patients were 75.53%（71/94）,58.51%（55/94）,52.13%（ 49/94）,15.96%（ 15/94） and 34.04%（ 32/94） respectively.The detection rate of MYC gene abnormality was 20.93%（9/43） and the detection rate of BCL-2 gene abnormality was 44%（ 22/50）; 2 kinds of gene abnormalities were of multiple copies,and 2 cases（ 2.13%） were abnormal in MYC and BCL-2 genes simultaneously.The median survival time of 3 years in 94 patients was 21.79 months（2-36 months）,and the overall survival rates of 1 and 3 years were 82.98% and 64.89% respectively.Single factor analysis revealed that the high ECOGscore（ ≥ 2）,high international prognostic index（ IPI） classification,positive expression of BCL-6 protein,and MYC and BCL-2 gene simultaneously abnormal were the risk factors influencing the prognosis（ all P〈0.05）.COX regression analysis showed that IPI classification, ECOGscore and treatment methods were independent factors influencing the prognosis（ all P〈0.05）.Conclusion： IPI classification,ECOGscore and treatment methods have greater impacts on the prognosis of patients with DLBCL.Chemotherapy combined with radiotherapy or surgical treatment can significantly improve the prognosis of patients.

关 键 词：弥漫大B细胞淋巴瘤 临床病理特征 预后因素 BCL-2蛋白 MYC蛋白 

分 类 号：R733.1[医药卫生—肿瘤]