摘要
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.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2013年第9期737-740,共4页
Chinese Journal of Hematology