中国人弥漫大B细胞淋巴瘤新分类模型的预后分析

The clinical significance of a new classification algorithm in Chinese DLBCL cases

目的探讨中国人弥漫大B细胞淋巴瘤（Diffuselarge B-cell lymphoma，DLBCL）的临床病理学、免疫表型特点及其与临床预后之间的关系；分析Hans及Chan分类模型对DLBCL患者的预后意义，寻找能够提示预后和指导临床治疗的最适合国人DLBCL的分类模型。方法对181例DLBCL患者病理组织石蜡切片进行免疫组化染色，检测Ki-67、CD3、CD20、CD79a、Bcl-6、CD10、Mum．1、GCETl、FOXPl的表达。并根据蛋白水平检测结果使用Hans模型及Chan模型进行分组并结合临床数据进行分析。结果181例患者中，男女比例为1．26：1。平均年龄53．5岁，中位年龄57（2～85）岁。181例患者中61例（33．7％）累及淋巴结，120例结外患者中以胃肠道最为多见（43例，35．8％）。随访时间1～120个月，3年生存率为49．7％，18个月内为患者死亡高发时间。R．CHOP（利妥昔单抗、环磷酰胺、多柔比星、长春新碱、泼尼松）方案化疗组患者3年生存率为76．9％，明显优于单纯使用CHOP方案的患者（61．9％）（P=0．017）。Ki-67、CD3、CD20、CD79a的阳性率分别为96．4％、0、98．3％和80．5％。GCETl、CD10、Bcl-6、Mum-1、FOXPl在DLBCL患者中均有一定的表达，但与预后均无明显相关性（P〉0．05）。Hans模型分组，生发中心B细胞样（GCB）组78例，Non—GCB组103例，生存分析显示两组预后差异无统计学意义（P〉0．05）；Chan模型分组，GCB组68例，Non．GCB组113例，生存分析显示GCB组患者预后明显好于Non—GCB组（P〈0．05）。结论中国人DLBCL流行病学特点、临床病理学特点与西方人群基本一致。Chan模型可用于国人DLBCL的预后提示。

Objective To investigate the clinieopathologic features, pathogenesis, diagnostic criteria and the relationship between different classification models and prognosis in Chinese patients with DLBCL, and try to look for the most appropriate classification model to predict clinical prognosis and therapeutic re- sponses for Chinese patients with DLBCL. Methods 181 cases of Chinese DLBCLs diagnosed according to the WHO 2008 classification were collected. Standard two-step Envision method of immunohistochemical stai- ning was used to assess the expressions of CD20, CD3e, CD79a, CDIO, Mum-1, Bel-6, GCET-1, FOXP1 and Ki-67. The phenotypic classifications were assessed according to the standard of Hans model and Chan model. Data were analyzed by X2 test and Life Table survival analysis with the SPSS14.0 statistical package. Results The ratio of male to female in this cohort was 1.26： 1. The median age of all patients was 57 yrs with the average age of 53.5 yrs. Of 61 cases （33.7%） primarily showed lymph node involvement. Gastroin- testinal tract as the most involved extra-nodal organ was observed in 43 cases （ 35.8% ）. All patients with complete clinical follow-up materials survived from 1 - 120 months. The patients showed a high risk for death in the initial one and half years. Three year survival rate was 49.7% （90/181）. Three year survival of 44 ca- ses received R-CHOP （Rituximab, cyclophosphamide, doxorubicin, vincristine, bolus） was 76.9% （20/ 26）, whereas 61.9%, （60/97） in 119 cases received CHOP alone, R-CHOP group showed better prognosis （P =0. 017）. All cases expressed one or more pan B cell markers, such as CD20 （176/179, 98.3% ） and CD79a （62/77, 80.5% ）. For Hans model, 78 cases were classified as GCB group, while 103 cases as Non- GCB group. The ratio of Non-GCB to GCB was 1.32 without difference on the survival （ P 〉 0.05 ）. For the Chan＇s algorithm, 68 cases belonged to GCB subgroup, while 113 cases non-GCB subgroup. The ratio of non-GCB to GCB was 1.66. GCB subtype showed much better prognosis than non-GCB subtype according to Life Table survival analysis （ P 〈 0.05 ）. Conclusion The epidemiology and clinicopathologic features of Chinese DLBCLs were similarly with the western cases. Chan＇ s algorithm was a significant tool to predict the cell origin and clinical biology of Chinese DLBCLs.