弥漫性大B细胞淋巴瘤组织MYC和Bcl-2及Bcl-6检测的预后价值

Prognosis judgment value of MYC,Bcl-2 and Bcl-6 detection in patients with diffuse large B cell lymphom

目的探讨检测MYC、Beb2和Bcl-6在弥漫性大B细胞淋巴瘤患者预后判断中的价值。方法回顾性分析郑州人民医院2007—06—01—2009—06一01确诊的159例弥漫性大B细胞淋巴瘤组织标本，间期荧光原位杂交方法检测MYC断裂、IGH／Bcl-2融合及Bcl-6基因断裂；免疫组织化学方法检测MYC、Bcb2及Bc卜6的表达丰度，并分析其与患者免疫学分型及预后的关系。结果国际预后指数（international prognosticindex，IPI）评分较高（IPI为3～5）的患者MYC表达高于IPI评分较低组（IPI为o～2），χ2=1．25；P=0．04；CD5＋与生发中心B细胞样（germinal center B-cell-like，GCB）亚型患者的Bcl-2表达增高，χ2值分别为2．22和13．70，P值分别为0．001和0．002；Bcl-6的表达降低，χ2值分别为5．58和7．26，P值分别为0．004和0．007。MYC、Bcl-2低表达均使患者的总生存时间（overall survival，OS）和无进展生存期（progression-free survival，PFS）的风险比（hazard ratio，HR）增加，P值分别为0．005、0．016、0．003和0．001，Bcb6的高表达使患者的PFS的HR增加，P=0．035；IPI评分较低患者较评分较高患者的OS与PFS的HR增加，P值均为0．001。结论MYC、Bcl-2和Bel-6检测对弥漫性大B细胞淋巴瘤患者的预后具有判断价值，可作为判断顸后的分子标志物。

OBJECTIVE To investigate the prognosis judgment value of MYC/Bcl-2/ Bcl-6 detection in patients with diffuse large ]3 cell lymphoma. METHODS A retrospective analysis of 159 patients with diffuse large B cell lymphoma tissue specimens were conducted in Zhengzhou People＇s Fiospital from June 1,2007 to June 1,2009. FISH was used to detect the break of gene MYC and Bcl-6 and the fusion of IGH/Bcl-2, the expression levels of MYC, Bcl-6, Bcl-2 in the tumor tissue were detected by immunohistochemistry. The relationship of MYC/Bcl-2 break and the fusion of IGH/Bcl-2 with the prognosis of patients were analyzed. RESULTS The expression of MYC in low IPI group （IPI= 3--5） was higher than that of low IPI score group （IPI= 0-2;χ2= 1.25, P= 0.04）. In CD5＋ and GCB subgroup,the expression of Bcl-2 was increased （χ2=2.22,P=0.001;χ2=13. 70,P=0. 002） ,but the Bcl-6 was decreased （χ2=5. 58,P=0. 004; χ2=7.26,P=0. 007）. Lower expression of MYC,Bcl-2 lead to a higher HR of OS and PFS （P values were 0. 005, 0. 016, 0. 003 and 0. 001）, higher expression of Bcl-6 lead to a higher FIR of PFS （P= 0. 035）. Low IPI score was also lead to high HR of PFS and OS than that of high IPI score （Both P values were 0. 001）. CONCLUSION The expression of MYC,Bcl-2 and Bcl-6 can predict the prognosis of DLBCL,they can be used in the future as prognostic markers for patients with DLBCL.