原发性CD5阳性的弥漫性大B细胞淋巴瘤的临床病理学特征  

Clinicopathological features of de novo CD5-positive diffuse large B-cell lymphoma

作　　者：樊月 董磊[1] 欧阳斌燊 许海敏[1] 郑赛芳 王安然 王朝夫[1] Fan Yue;Dong Lei;OUYang Binshen;Xu Haimin;Zheng Saifang;Wang Anran;Wang Chaofu(Department of Pathology,Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院病理科,200025

出　　处：《中华病理学杂志》2020年第5期448-453,共6页Chinese Journal of Pathology

摘　　要：目的探讨C-MYC、bcl-2、bcl-6蛋白的表达与原发性CD5阳性的弥漫性大B细胞淋巴瘤(CD5-positive diffuse large B cell lymphoma,CD5+DLBCL)患者临床病理特征之间的关系。方法收集2013年2月至2018年9月上海交通大学医学院附属瑞金医院初治诊断为原发性CD5+DLBCL标本57例,采用HE染色、免疫组织化学技术及荧光原位杂交(FISH)法,检测原发性CD5+DLBCL中C-MYC、bcl-2、bcl-6蛋白的表达情况,并分析其与临床病理特征之间的关系。结果57例原发性CD5+DLBCL中,男性27例,女性30例,发病年龄35~99岁。C-MYC、bcl-2、bcl-6蛋白表达阳性率分别为50.9%(29/57)、84.2%(48/57)、75.4%(43/57),其中C-MYC和bcl-2双表达阳性率为40.4%(23/57);其在患者性别、临床分期、血清乳酸脱氢酶(LDH)水平、β2微球蛋白水平、国际预后指数(IPI)评分、B症状、骨髓侵犯和中枢神经系统(CNS)复发等临床特征之间差异无统计学意义(P>0.05);单因素生存分析显示:C-MYC阴性患者中位总生存率显著高于阳性患者(P=0.010),双表达阴性患者中位总生存率显著高于阳性患者(P=0.008),bcl-6阳性患者中位总生存率显著高于阴性患者,差异具有统计学意义(P=0.021),bcl-2蛋白表达与预后无明显相关性(P>0.05);Cox模型多因素分析显示,C-MYC蛋白表达可作为原发性CD5+DLBCL患者总生存率的独立预测指标(P=0.034)。结论C-MYC、bcl-2、bcl-6蛋白在原发性CD5+DLBCL的预后价值中,bcl-2表达对预后无影响,bcl-6阳性组预后较好,C-MYC蛋白表达可作为预测原发性CD5+DLBCL患者预后的独立有效指标,但对于原发性CD5+DLBCL患者中,C-MYC、bcl-2及bcl-6蛋白的表达与C-MYC、bcl-2及bcl-6基因重排之间的关系,还有待扩大样本量进一步深入探讨。Objective To investigate the relationship between the protein expression of C-MYC,bcl-2 and bcl-6 and the clinicopathological characteristics in patients with de novo CD5-positive diffuse large B cell lymphoma(CD5+DLBCL).Methods Fifty seven cases of de novo CD5+DLBCL were collected at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from February 2013 to September 2018.The hematoxylin-eosin stained slides were reviewed,and immunohistochemical(IHC)staining and FISH were used to analyze the relationship between C-MYC,bcl-2,bcl-6 expression and the clinicopathologic characteristics of patients.Results Among these 57 cases,27 were male and 30 were female.The age of onset was 35-99 years old.The IHC expression rates of C-MYC,bcl-2 and bcl-6 were 50.9%(29/57),84.2%(48/57),and 75.4%(43/57)respectively;and co-expression rate of C-MYC and bcl-2 proteins was 40.4(23/57).There was no significant correlation between protein expression and patients′genders,clinical stage,the level of serum LDH,β2 microglobulin,IPI,B symptoms,bone marrow involvement and central nervous system recurrence(P>0.05).Univariate analysis showed that the median OS of C-MYC negative patients was significantly longer than C-MYC positive patients(P<0.05);and the median OS of patients without double expression was significantly longer than that of patients with positive expression(P<0.05),and bcl-6 positive patients had longer median OS than bcl-6 negative patients(P<0.05).There was no significant correlation between prognosis and bcl-2 protein expression(P>0.05).Cox multivariate analysis showed C-MYC protein expression was an independent predictor of OS in de novo CD5+DLBCL(P<0.05).Conclusions Bcl-2 protein expression has no effect on the prognosis in de novo CD5+DLBCL whereas bcl-6 expression is correlated with good prognosis.C-MYC protein expression could be used as an independent and effective index to predict the prognosis of patients with de novo CD5+DLBCL.However,the relationship between protein expression and gene r

关 键 词：淋巴瘤 淋巴瘤 B细胞 抗原CD5 原癌基因蛋白质C-MYC 基因 BCL-2 

分 类 号：R733[医药卫生—肿瘤]