HBV相关弥漫大B细胞淋巴瘤临床特征、BCL-2、CMYC表达及预后分析

The clinical features,BCL-2,CMYC protein expression and prognosis of the hepatitis B virus-associated diffuse large B-cell lymphoma

目的探讨乙型肝炎病毒(HBV)相关弥漫大B细胞淋巴瘤(DLBCL)临床特征、BCL-2、CMYC表达的相关性及预后分析。方法回顾性分析94例DLBCL患者病例资料。利用免疫组化法检测其肿瘤组织石蜡切片中BCL-2、CMYC蛋白表达的情况,分析HBV相关DLBCL患者的临床特征、蛋白表达及预后比较。结果 1 94例DLBCL患者中乙肝感染率(Hbs Ag+)为27.66%,明显高于普通人群(7.18%);Hbs Ag(+)组DLBCL患者与Hbs Ag(-)组相比:疾病分期更晚(P=0.032)、国际预后指数(IPI)评分更高(P=0.047)、脾脏更易受累(P=0.02);在性别分布、年龄、免疫学亚型、化疗疗程方面无显著差异;2两组在BCL-2、CMYC蛋白表达方面:Hbs Ag(+)组BCL-2蛋白表达明显高于Hbs Ag(-)组(84.6%vs 58.8%,P=0.018),在CMYC蛋白表达、BCL-2/CMYC"双表达"方面无显著差异;3单因素生存分析显示乙肝病毒感染、BCL-2阳性、CMYC阳性、CMYC/BCL-2双表达、IPI高危组均为总生存期(OS)和无疾病进展生存期(PFS)的不良预后因素;Cox多因素分析显示,CMYC/BCL-2双表达、IPI高危组均为OS、PFS独立的不良预后因素。结论 HBV相关弥漫大B细胞淋巴瘤具有独特的临床特征;HBV感染、BCL-2、CMYC、BCL-2/CMYC双表达、IPI均与DLBCL预后相关;HBV感染可能通过调控BCL-2作用影响DLBCL发生发展及预后。

Objective To investigate the clinical features,BCL-2,CMYC protein expression and prognosis of patients with hepatitis B virus-associated diffuse large B-cell lymphoma（DLBCL）. Methods A retrospective study was used to analyse 94 diagnosed DLBCL patients clinical data. Immunohistochemistry method was used to detect the expression of BCL-2 and CMYC protein in paraffin sections of tumor tissues,and to analyze the clinical features,protein expression and prognosis of patients with hepatitis B virus-associated DLBCL. Results 1 The rate of HBV infection in the 94 DLBCL patients was 27. 66%,significantly higher than the general population（7. 18%）.Compared with Hbs Ag-negative DLBCL,Hbs Ag-positive DLBCL displayed more advanced disease（P = 0. 032）,higher international prognostic index（IPI）（P = 0. 047） and more frequent involvement of spleen（P = 0. 02）.There were no significant differences in gender distribution,age,immunological subtype and treatment between the two groups. 2 The aspect of BCL-2 and CMYC protein expression between the two groups： Hbs Ag-positive group BCL-2 protein expression was significantly higher than Hbs Ag-negative group（84. 6% vs 58. 8%,P = 0. 018）.There were no significant differences on the CMYC protein expression and CMYC/BCL-2 ＂double expression＂. 3Univariate survival analysis showed that hepatitis B virus infection,BCL-2 positive,CMYC positive,CMYC/BCL-2 ＂double expression＂,IPI high-risk group were associated with unfavorable prognostic of overall survival time（OS） and progression free survival（PFS）. Cox multivariate analysis showed that CMYC/BCL-2 ＂double expression＂,IPI high-risk group were independent adverse prognostic factors for OS and PFS. Conclusion HBV infection,BCL-2,CMYC,BCL-2/CMYC ＂double expression＂,IPI are related to the prognosis of DLBCL. HBV infection may affect the development and prognosis of DLBCL by regulating the expression of BCL-2.