CD56抗原表达在急性早幼粒细胞白血病中的临床意义和预后分析  

Clinical significance and prognostic analysis of CD56 antigen expression in acute promyelocytic leukemia

作　　者：何杰 董海波[1] 张启国[1] 周荣富[1] 许景艳[1] 杨永公[1] 许佩佩[1] 张谦[1] 陈兰昕[1] 周敏[1] 袁翠英[1] 蒋如如 刘锦雯 欧阳建[1] 陈兵[1] 曾慧[1] HE Jie;DONG Haibo;ZHANG Qiguo;ZHOU Rongfu;XU Jingyan;YANG Yonggong;XU Peipei;ZHANG Qian;CHEN Lanxin;ZHOU Min;YUAN Cuiying;JIANG Ruru;LIU Jinwen;OUYANG Jian;CHEN Bing;ZENG Hui(Department of Hematology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院血液科,南京210008

出　　处：《临床血液学杂志》2023年第7期508-513,519,共7页Journal of Clinical Hematology

摘　　要：目的:分析CD56抗原在初诊急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)中的表达及其与临床参数之间的相关性,探究该抗原的临床意义及对预后的影响。方法:回顾性分析169例初诊APL患者的临床数据,按照CD56抗原表达状况,将其分为CD56阳性和CD56阴性组,比较2组患者性别、年龄、体能状态(ECOG)、血细胞计数、生化指标、凝血功能、骨髓及外周血早幼粒细胞比例、免疫分型、危险分层、FLT3突变、染色体核型、PML/RARα异聚体类型及融合率、FAB分型(M3a/M3b/M3v)、弥散性血管内凝血(disseminated intravascular coagulation,DIC)积分等参数有无差异。以达分子学缓解(molecular complete remission,mCR)的时间为界,将临床事件分为早期事件(分化综合征、QT间期延长、出血、栓塞、死亡)和晚期事件(继发第二肿瘤、QT间期延长、出血、疾病复发、死亡),比较2组早晚期事件发生率的差异。探索CD56阳性表达对总生存期(OS)、无进展生存期(PFS)及无事件生存期(EFS)的影响。结果:169例APL患者中,17例患者CD56阳性,该抗原的阳性表达率为10.1%。CD56阳性和阴性患者在D-二聚体水平和共表达CD64抗原方面比较,差异有统计学意义(P=0.016,0.017)。CD56阳性组患者达mCR时间更长(P=0.023),2组患者的早期事件发生率差异无统计学意义,2组患者的疾病复发事件差异有统计学意义(P=0.014)。中位随访63.0个月,CD56阳性患者具有更差的OS、PFS和EFS(P=0.023,0.004,<0.001)。多因素分析显示CD56阳性是PFS、EFS的独立不良因素(P=0.018,<0.001)。结论:CD56阳性是APL的预后不良因素,临床医师需根据该抗原的表达与否决定APL患者的全程管理策略。Objective:To analyze the expression of CD56 antigen in newly diagnosed acute promyelocytic leukemia(acute promyelocytic leukemia,APL)and its correlation with clinical parameters,and to explore the clinical significance of this antigen and its influence on the prognosis.Methods:Clinical data from 169 patients with new diagnosis APL in our hospital were retrospectively analyzed.According to the expression of CD56 antigen,patients were divided into CD56 positive group and CD56 negative group.The gender,age,ECOG,blood cell count,biochemical criterion,coagulation function,bone marrow and peripheral blood promyelocytic proportions,immunophenotype,risk stratification,FLT3 mutation,chromosome karyotype,PML/RARαheteromer type and fusion rate,FAB type(M3a/M3b/M3v),disseminated intravascular coagulation(DIC)score were compared between the two groups.Based on the time to molecular complete remission(mCR),clinical events were divided into early events(differentiation syndrome,QT prolongation,bleeding,embolism,death)and late events(secondary tumor,QT prolongation,bleeding,disease recurrence,death),and the difference in the incidence of early and late events was compared.To explore the effects of CD56 positive expression on overall survival(OS),progression-free survival(PFS)and event-free survival(EFS).Results:Among 169 patients with APL,17 patients were positive for CD56,and the positive expression rate was 10.1%.There were significant differences in D-dimer level(P=0.016)and expression of CD64 antigen(P=0.017).CD56 positive group had longer time to reach mCR(P=0.023),and no significant difference was observed in the incidence of early events,while the incidence of disease recurrence event was distinctly different between the two groups(P=0.014).With a median follow-up period of 63.0 months,CD56 positive patients had worse OS,PFS,and EFS(P=0.023,0.004,<0.001).Multivariate analysis suggested that the expression of CD56 was an independent adverse factor of PFS and EFS(P=0.018,<0.001).Conclusion:CD56 positive expression is a poo

关 键 词：急性早幼粒细胞白血病 CD56抗原表达 临床特征 预后分析 

分 类 号：R733.71[医药卫生—肿瘤]