MYC/BCL-2蛋白双表达弥漫大B细胞淋巴瘤患者的临床特征及预后影响因素分析  

Analysis of clinical characteristics and prognostic factors for patients with diffuse large B-cell lymphoma and double expression of MYC/BCL-2

作　　者：程丽华 杨福冬 张娜[1] 周婕[1] Cheng Lihua;Yang Fudong;Zhang Na;Zhou Jie(Department of Hematology,People's Hospital of Deyang City,Deyang 618000,China)

机构地区：[1]德阳市人民医院血液科,德阳日618000

出　　处：《国际输血及血液学杂志》2022年第6期513-522,共10页International Journal of Blood Transfusion and Hematology

基　　金：德阳市科技计划重点研发项目(2020SZZ092)。

摘　　要：目的探讨MYC/B细胞淋巴瘤(BCL)-2蛋白双表达弥漫大B细胞淋巴瘤(DE-DLBCL)患者的临床特征及预后影响因素。方法选择2011-2021年德阳市人民医院收治的128例新诊断(DLBCL)患者为研究对象。其中,男、女性患者分别为76和52例;18~60、61~74、≥75岁患者分别为60、48和20例。根据患者的MYC和BCL-2蛋白表达水平,将其分为DE-DLBCL组(n=63,BCL-2蛋白表达水平>50%且MYC蛋白表达水平>40%)和非DE-DLBCL组(n=65,不满足DE-DLBCL的诊断标准)。采用回顾性研究方法,收集2组DLBCL患者的疗效及预后相关临床资料。DLBCL患者的一线治疗方案主要采用R(利妥昔单抗)-CHOP(环磷酰胺+多柔比星+长春新碱+泼尼松)或CHOP样方案,对患者的随访截至2021年3月15日。采用χ^(2)检验对2组患者不同临床特征的构成比进行比较;生存分析采用Kaplan-Meier法,2组比较采用log-rank检验;采用Cox比例风险回归模型对可能影响患者生存期的临床资料进行单因素及多因素分析。本研究遵循的程序符合《世界医学协会赫尔辛基宣言》要求。结果①与非DE-DLBCL组患者比较,DE-DLBCL组中Ann Arbor分期为Ⅲ~Ⅳ期[69.8%(44/63)比52.3%(35/65)],美国东部肿瘤协作组体能状态(ECOG-PS)评分≥2分[93.7%(59/63)比72.3%(47/65)]、乳酸脱氢酶(LDH)水平≥250 U/L[61.9%(39/63)比36.9%(24/65)],中枢神经系统(CNS)-国际预后指数(IPI)评分≥2分[88.9%(56/63)比64.6%(42/65)]、肿瘤包块直径≥7.5 cm[44.4%(28/63)比21.5%(14/65)]、非生发中心样B细胞(non-GCB)亚型[84.1%(53/63)比61.5%(40/65)]、P53阳性[65.1%(41/63)比36.9%(24/65)]患者的比例升高,并且差异均有统计学意义(χ^(2)=4.132、10.239、7.988、10.505、7.614、8.217、10.148,P=0.042、0.001、0.005、0.001、0.006、0.004、0.001)。②与非DE-DLBCL组患者比较,DE-DLBCL组患者的完全缓解(CR)率[68.3%(43/63)比84.6%(55/65)]、中位无进展生存(mPFS)期[29.0个月(95%CI:22.3~35.6个月)比未达到(95%CI:64.2~100.0个月)]、中位Objective To investigate clinical characteristics and prognostic factors of patients with MYC/B-cell lymphoma(BCL)-2 protein double expression diffuse large B-cell lymphoma(DE-DLBCL).Methods From 2011 to 2021,a total of 128 newly diagnosed diffuse large B-cell lymphoma(DLBCL)patients in People′s Hospital of Deyang City were selected as research subjects.There were 76 male and 52 female patients;and 60,48 and 20 patients aged 18-60,61-74 and over 75,respectively.According to the expression level of MYC and BCL-2 protein,the patients were divided into DE-DLBCL group(n=63,BCL-2 protein expression level>50% and MYC protein expression level>40%)and non DE-DLBCL group(n=65,not meeting the diagnostic criteria of DE-DLBCL).A retrospective study was conducted to collect clinical data related to efficacy and prognosis of DLBCL patients in both groups.R(rituximab)-CHOP(cyclophosphamide+doxorubicin+vincristine+prednisone)or CHOP like regimen was mainly used as the first-line treatment for DLBCL patients,and the follow-up of patients was up to March 15,2021.The composition ratios of different clinical characteristics of patients in two groups were compared by chi-square test.Kaplan Meier method and log-rank test were used for survival analysis and comparison between 2 groups.Cox proportional hazard regression model was used to univariate and multivariate analyze the factors that may affect the survival of patients.This study was conducted in accordance with the requirements of the World Medical Association Declaration of Helsinki revised in 2013.Results①Compared with patients in non DE-DLBCL group,the proportion of patients in the DE-DLBCL group with Ann Arbor stage Ⅲ-Ⅳ[69.8%(44/63)vs 52.3%(35/65)],the Eastern Cooperative Oncology Group performance status(ECOG-PS)score≥2 scores[93.7%(59/63)vs 72.3%(47/65)],lactate dehydrogenase(LDH)level≥250 U/L[61.9%(39/63)vs 36.9%(24/65)],central nervous system(CNS)-International Prognostic Index(IPI)score≥2 scores[88.9%(56/63)vs 64.6%(42/65)],tumor mass diameter≥7.5 cm[44.4

关 键 词：淋巴瘤 大B细胞 弥漫性 原癌基因蛋白质C-MYC 原癌基因蛋白质C-BCL-2 预后 危险因素 双表达 

分 类 号：R733.1[医药卫生—肿瘤]