147例弥漫大B细胞淋巴瘤患者的临床特点及预后分析

The clinical characteristics and prognostic analysis of 147 cases of diffuse large B- cell lymphoma

目的了解弥漫大B细胞淋巴瘤（DLBCL）患者的临床特点、病理学特征、免疫标记与预后的关系。方法收集147例初发DLBCL患者的临床资料，对其病理组织切片采用免疫组化二步法检测CD10、Bcl-6、MUM1、FOXP1、GCET1、CD5、Bcl．2、Ki-67的表达情况，并根据Hans分型及Choi分型进行预后分析比较。结果①对147例DLBCL患者的临床资料进行Kaplan—Meier单因素分析，发现AnnArbor分期I～Ⅱ期（P=0．032）、IPI评分0-2分（P=0．001）、结外累及≤1处（P=-0．014）、获得完全缓解（P=-0．000）的患者总体生存更好，上述因素与预后相关；但性别、年龄、LDH、B症状、治疗方案与预后无关（P值均，0．05）。②127例进行免疫组化分型的患者中，根据Hans分型，生发中心B细胞样（GCB）型42例，活化B细胞样（ABC）型85例；根据Choi分型，GCB型47例，ABC型80例。Kaplan．Meier单因素分析结果显示Choi分型中GCB型和ABC型患者的3年总生存率分别为78．5％和60．9％，差异有统计学意义（P=0．047）；而Hans分型中GCB型和ABC型患者的3年总生存率分别为71．8％和79．6％，差异无统计学意义（P=0．285）。③在70例R—CHOP方案治疗患者中，以Ki-67的中位数75％分组，低Ki，67组（P=0．017）和CD5表达阴性组（P=-0．012）患者预后更好。且COX风险比例回归模型分析结果显示IPI评分（尸=0．002）和Ki-67（P=0．019）是独立的不良预后因素。结论AnnArbor分期、IPI评分、结外累及、疾病缓解和Ki-67与患者预后明显相关，Choi分型较Hans分型更能体现GCB和ABC亚型在预后上的差异，ABC型与不良预后相关，同时Ki．67和IPI评分是独立的不良预后因素。

Objective To investigate the relationship between the clinical features, pathogenesis, immunophenotype, different classification models and prognosis in Chinese patients with diffuse large B-cell lymphoma（DLBCL）. Methods A total of 147 patients with DLBCL who were treated with CHOP- like or R-CHOP were subjected to analysis. Standard two-step Envision method of immunohistochemical staining was used to assess the expression of CD10, Bcl-6, MUM1, FOXP1, GCET1, CD5, Bcl-2, Ki-67, then according to Hans algorithm, Choi algorithm and Molecular markers ,we compared the differences of their prognosies. Results @Kaplan-Meier univariate analysis of the clinical data of 147 DLBCL patients found that the 3-year overall survival （OS） rates were better in early stage （P=0.032）, low IPI score （P=- 0.001）, less than one extranodal involvement （P=0.014）, and complete remission （P〈0.01）. The prognosies had no significant differenced in terms of gender, age, LDH, B symptoms and treatment options （P value 〉 0.05）. @For Hans model, GCB group had 42 cases, the ABC group 85 cases; GCB were 47 cases, ABC 80 cases （according to Choi model）. Choi model suggested GCB subtype showed much better prognosis than ABC subtype （P=0.047）, while Hans model shed no statistically significant difference （P= 0.285）. @Ki-67 of 75% was found to significantly discriminate patients with good or bad prognosis. In R-CHOP group at the same time, low Ki-67 （P=-0.017） and CD5-negative groups （P=-0.012） were better. Cox proportional hazards regression model showed that IPI score （P=0.002） and Ki-67 （P=0.019） were independent adverse prognostic factors. Conclusion The Ann Arbor stage, IPI score, extranodal involvement status and Ki-67 were significantly associated with prognosis .Compared to Hans algorithm, Choi had an advantage to predict the differente prognosis between subtypes, and ABC group had poor outcome. Finally, both Ki-67 and IPI score were independent adverse prognostic factors.