白血病细胞CD56抗原表达与急性髓系白血病患者预后的关系

Relationship between CD56 antigen expression in leukemia cells and prognosis of patients with acute myeloid leukemia

目的：探讨急性髓系白血病（AML）患者白血病细胞CD56抗原表达与预后的关系,阐明CD56抗原表达在预测AML患者预后中的作用。方法：收集171例年龄14~60岁、采用去甲氧柔红霉素＋阿糖胞苷（IA）方案首次诱导化疗的初治AML（AML-M3除外）患者的临床资料,流式细胞术检测白血病细胞CD56抗原的表达。采用COX回归模型分析患者生存时间的影响因素,采用双变量相关分析研究患者CD56阳性率与总生存时间（OS）间的关系。根据CD56抗原表达将患者分为CD56＋组（n=52）和CD56-组（n=119）,同时根据CD56阳性表达率,以50%为界限,将CD56＋组分为CD56阳性表达率≥50%组（n=39）和CD56阳性表达率〈50%组（n=13）,比较CD56＋组和CD56-组、CD56阳性表达率≥50%组和CD56阳性表达率〈50%组患者完全缓解率（CRR）、复发率、中位OS、中位无病生存时间（DFS）和生存率。结果：CD56＋组患者中位OS（14.2个月）低于CD56-组（39.4个月）、CD56阳性表达率≥50%组患者中位OS（11.7个月）低于CD56阳性表达率〈50%组（20.3个月）,差异均有统计学意义（P〈0.05）。CD56＋组患者1年和2年生存率（61.5%、46.2%）低于CD56-组（75.6%、63.9%）（P〈0.05）;CD56阳性表达率≥50%组患者1年生存率（53.8%）与CD56阳性表达率〈50%组（84.6%）比较差异无统计学意义（P〉0.05）,但CD56阳性表达率≥50%组患者2年生存率（41.0%）明显低于CD56阳性表达率〈50%组（61.5%）（P〈0.05）。CD56＋组患者CRR（63.5%）与CD56-组（68.9%）以及CD56阳性表达率≥50%组（58.9%）与CD56阳性表达率〈50%组（76.9%）比较,差异均无统计学意义（P〉0.05）。CD56＋组患者总复发率和1年内复发率（64.3%、37.5%）均高于CD56-组（34.3%、17.9%）（P〈0.05）,而CD56阳性表达率≥50%组总复发率、1年内复发率（75.0%、42.9%）与CD56阳性表达率〈50%组（37.5%、16.7%）比较,差异均无统计学意义（P〉0.05）;CD56＋组患者中位DFS（12.7个月）低于CD56-组（34.1个月）（P〈0.05）;CD56阳性表达率≥50%组与CD56阳性表达率〈50%组中位DFS比较差异有统计学意义（P〈0.05）。结论：白血病细胞CD56抗原表达阳性是AML患者预后的不良因素,且阳性率越高,提示其预后越差。

Objective： To investigate the expression of CD56 antigen in leukemia ceils of the patients with acute myeloid leukemia （AML） and its relationship with the prognosis of AML, and to clarify the role of CD56 antigen expression in predicting the prognosis of the AML patients. Methods.. 171 AML （non-M3） patients aged from 14 to 60 years old, who received a IA Regimen as the first time inducing chemotherapy were chosen. Flow cytometric analysis was used to evaluate the CD56 expression in leukemia cells. COX proportional regression analysis was used to select the prognostic factors, and bivariable analysis was used to study the relationship between the positive rate of CD56 and overall survival （OS）. The CD56＋ group （n=52）, including CD56-50% expression group （n：39） and CD56〈50% expression group （n= 13）, and CD56- group （n= 119） were identified by the expression of CD56 antigen. The complete remission rate （CRR）, the relapse rate, the median OS, the median disease-free survival （DFS） and the survival rate of patients were compared. Results.. The medium OS of the patients in CD56＋ group （14.2 months） was shorter than that in CD56 group （39.4 months） （P〈0.05）. Moreover, the medium OS in CD56～50% group was shorter than that in CD56～50% group （11.7 months vs 20.3 months, P〈0.05）. The 1- year and 2-year survival rates of the patients in CD56＋ group （61.5%, 46.2%） were lower than those in CD56 group （75.6%, 63.9%） （P〈0.05）. The 1-year survival rate had no significant difference between CD56～50% group and CD56～50% group （53.8% vs 84.6%, P〉0.05）, while the 2-year survival rate in CD56～50% group was lower than that in CD56～50% group （41.0% vs 61.5%, P〈0.05）. There were no significant differences of the CRR between CD56＋ group （76.9%） and CD56- group （68.9%） as well as CD56～50% group （58.9%） and CD56～50% group （63.5%） （P〉0.05）. The relapse rate and first year relapse rate of patients in CD56＋ group （64.3% and 37.5%） were significantly higher than those in CD56- group （34.3% and 17.9% ） （P～0.05）. However, there were no significant differences of the relapse rate and first year relapse rate between CD56～50% group （75.0% and 42.9%） and CD56～50% group （37.5% and 16.7%） （P～0.05）. The DFS in CD56＋ group was shorter than that in CD56- group （P〈0.05）. The same DFS result was also found between CD56～50% group and CD56～50% group （P〈0.05）. Concldusion： The expression of CD56 antigen in leukemia cells predicts a bad prognosis in the AML patients, and the higher expression of CD56 indicates the worse prognosis.