CD20阳性经典霍奇金淋巴瘤的临床特点及预后分析

Clinical features and prognosis of CD20-positive classical Hodgkin lymphoma

目的分析CD20阳性经典霍奇金淋巴瘤（CHL）的临床特点和预后。方法回顾性分析2007年9月至2014年3月中国医学科学院肿瘤医院收治的有CD20免疫组化检测结果的CHL患者的临床资料，分析Reed－Sternberg（R－S）细胞CD20是否表达与CHL病理亚型、临床特点和预后关系。采用Fisher检验方法进行组间比较，Kaplan－Meier法进行生存分析。结果共纳入263例患者，其中CD20阳性74例（28.1%）。CD20阳性患者中EB病毒感染相关CHL、混合细胞型和淋巴细胞丰富型患者的比例显著高于CD20阴性患者[52.8%（28/53）比19.0%（22/116），37.9%（25/66）比31.6%（54/171），22.7%（15/66）比3.5%（6/171），均P〈0.05]。中位随访40个月，单因素分析结果显示，EB病毒感染、年龄≥40岁，特别是年龄≥60岁、分期为Ⅲ～Ⅳ期与3年无进展生存（PFS）和总生存（OS）率下降有关（PFS： 70.3%比87.7%，79.2%比89.8%，56.8%比91.5%，70.4%比93.2%；OS：81.0%比100%，92.1%比99.4%，75.4%比99.2%，90.3%比100%；均P〈0.05）；而CD20阳性、未接受局部放疗与PFS率下降有关（79.7%比90.6%，68.8%比90.6%，均P〈0.05），与OS率无关（92.4%比98.3%，94.0%比99.4%，均P〉0.05）。CD20和EB病毒联合分析，二者均阳性的患者PFS率低。结论CHL中R－S细胞CD20的表达与EB病毒感染密切相关，EB病毒感染与预后不良相关，CD20阳性对预后的影响主要来自于EB病毒感染对预后的影响。

Objective To explore the clinical characteristics and prognosis of CD20-positive classical Hodgkin lymphoma （CHL）. Methods Data from CHL patients with CD20 immunohistochemical staining result who were treated in Cancer Hospital of Chinese Academy of Medical Sciences between September 2007 and March 2014 were reviewed. The relationship of CD20 expression in Reed-Sternberg （R-S） cells with CHL subtypes, clinical characteristics, and prognosis were analyzed. Fisher test was used to analyze the differences between groups and Kaplan-Meier for survival analysis. Results A total of 263 patients were included in this study. Among the 263 patients, 74 （28.1% ） were CD20-postitive. CD20- positive cases showed significantly higher proportions of Epstein-Barr virus （EBV） infection-related, mixed cellularity, and lymphocyte-rich CHL subtypes compared with CD20-negeative patients [ 52. 8% （28/53） vs 19.0% （22/116）, 37.9% （25/66）vs31.6% （54/171）, 22.7% （15/66）vs3.5% （6/171）, allP〈 0. 051. Univariate analysis identified EBV infection, age （≥ 40 years, especially ≥60 years） , and Ⅲ - Ⅳ stage were correlated with reduced 3-year progression-flee survival （PFS） and overall survival （OS） （PFS： 70.3 vs 87.7%, 79.2% vs 89.8%, 56.8% vs 91.5%, 70.4% vs 93.2% ; OS： 81.0% vs 100%, 92. 1% vs 99. 4%, 75.4% vs 99. 2%, 90. 3% vs 100% ; all P 〈0. 05） ; and CD20-positive and not receiving local radiotherapy were associated with reduced PFS （79.7% vs 90. 6%, 68. 8% vs 90. 6%, both P 〈0. 05）,not with OS （ 92. 4% vs 98. 3%, 94. 0% vs 99. 4%, both P 〉 0. 05 ）. Patients positive in both CD20 expression and EBV-eneoded small RNAs （EBER） showed low PFS. Conclusions CD20 expression in R-S cells in CHL may be closed related with EBV infection. EBV infection is associated with unfavorable prognosis. The effect of CD20-postitive on prognosis may be mediated by the prognostic effect of EBV infection.