CD40在弥漫性大B细胞淋巴瘤中的表达

Expression and clinical significance of CD40 in diffuse large B-cell lymphoma

目的 观察CD40在弥漫性大B细胞淋巴瘤（DLBCL）组织中的表达,探讨其与各种临床因素、临床病理特征以及预后的关系.方法 回顾性分析吉林省肿瘤医院2008年1月至2012年10月间诊断的DLBCL87例,应用免疫组织化学SP法检测CD40的表达情况,并且详细记录每位患者的临床特征、无病生存期和总生存期.应用统计软件对CD40在DLBCL中的表达情况、各临床因素及CD40与总生存期关系的数据进行分析.结果 CD40阳性的DLBCL患者具有年龄低、临床分期早、结外受累数少、国际预后指数（IPI）小、美国东部肿瘤协作组（ECOG）评分小的特点.但在性别与发病部位无明显相关性（P=0.141和0.729）.CD40阳性的患者总生存期显著高于阴性者.单因素分析结果显示DLBCL患者的预后与CD40表达、年龄、ECOG评分、IPI、结外受累数、乳酸脱氢酶（LDH）值等密切相关（均P＜0.05）.分层分析结果显示无论何种免疫表型CD40阳性的患者对比同种免疫表型组都具有更好的预后.COX模型多因素分析显示CD40表达同免疫分型、ECOG评分、临床分期、治疗方案与预后密切相关（均P ＜0.05）.结论 CD40可以作为DLBCL患者预后的指标,CD40阳性提示预后较好.

Objective To study the expression of CD40 in diffuse large B-cell lymphoma （DLBCL） and its relationship with various clinical parameters,pathologic findings and prognostic data.Methods The clinical information of 87 patients with DLBCL diagnosed in Jilin Province Cancer Hospital during the period from January,2008 to october,2012 was retrospectively reviewed,Immunohistochemical study using SP technique for CD40 was carried out.The correlation between clinicopathologic findings,CD40 expression and survival data was analyzed using statistical software.Results Cases of CD40-positive DLBCL were characterized by lower age group,early clinical stage,less extranodal involvement,lower IPI index and lower ECOG score.However,there was no significant correlation between gender of patients and site of involvement （P =0.141 and 0.729）.The overall survival of patients with CD40-positive DLBCL was significantly higher than that in patients with CD40-negative DLBCL.One-way analysis of variance showed that the prognosis of DLBCL was closely associated with CD40 expression,age of patients,ECOG score,IPI index,extranodal involvement and LDH level （P 〈 0.05,respectively）.Stratified analysis showed that CD40-positive DLBCL carried a better prognosis,irrespective of other immunophenotyping results.COX model multivariate analysis showed that the expression of CD40 closely correlated with other immunophenotyping results,ECOG score,clinical staging,treatment regimen and prognosis （P 〈 0.05）.Conclusion The expression of CD40 is a favorable prognostic indicator in patients with DLCBL.