T淋巴母细胞性淋巴瘤/白血病患者石蜡标本C-MYC基因和蛋白表达及其对预后的影响

C-MYC Gene and Protein Expression in Paraffin Wax of T Lymphoblastic Lymphoma and Leukemia Patients and Its Effect on the Prognosis

目的:探讨T淋巴母细胞性淋巴瘤/白血病(T-LBL/ALL)患者石蜡标本C-MYC基因和蛋白表达及其与预后的相关性。方法:选取本院于2005年5月至2016年5月期间有详细随访记录的T-LBL/ALL 60例石蜡标本作为研究组,应用免疫组织化学En Vision法对末端脱氧核苷酸转移酶(TDT)、髓过氧化物酶(MPO)、Ki-67和CMYC行免疫组织化学标记,并同期选取淋巴结反应性增生(RH)20例作为中C-MYC基因和蛋白表达异常的对照组。结果:在本次研究中,C-MYC基因断裂和拷贝数增加均未发生于20例RH。蛋白C-MYC表达率为66.7%(40/60),20例淋巴结反应性增生(RH)均为阴性(0/20)。蛋白C-MYC阳性表达率比较,差异具有统计学意义(P<0.05)。Ki-67阳性指数、纵隔增宽对C-MYC蛋白表达有影响(P<0.05),性别、原发部位、症状、年龄、Ann Arbor分期、乳酸脱氢酶(LDH)水平、骨髓累及对其无甚影响,差异无统计学意义(P>0.05)。分析生存期结果表明:1年总体生存率为24.3%。患者预后通过单因素分析与C-MYC蛋白的表达水平有关联(P<0.05)。蛋白阴性组的1年总生存率(44.0%)明显高于阳性组1年总生存率(15.0%)6例(10.0%)8q24染色体断裂发生,11例(18.3%)增加拷贝数。结论:在T-LBL/ALL的发生发展中,C-MYC的表达有重大意义,与预后差相关,可以作为一种独立的预后参考因素。

Objective： To explore the relevance between the expression of C-MYC gene and protein of patients with T lymphoblastic lymphoma and leukemia（ T-LBL/ALL） and its effect on the prognosis. Methods： Paraffin specimens from 60 cases of T-LBL/ALL with detailed follow-up during May 2005 to May 2016 were selected as study group; at same time 20 cases of reactive hyperplasia（ RH） of lymphonuedes were selected as control group. The immunohistochemical En Vision method was used to mark the terminal deoxynucleotidyl transferase（ TDT）, myeloperoxidase（ MPO）,Ki-67 and C-MYC immune tissue. Results： C-MYC gene rupture and copy number increase did not occur in 20 cases of RH. The expression of C-MYC protein did not correlate with C-MYC gene copy number increase. The expression rate of C-MYC protein was 66. 7%（ 40/60）,and 20 cases of lymph node RH was all negative（ 0/20）,as compared with the positive expression rate of protein C-MYC,the difference was statistically significant（ P〈0. 05）. The Ki-67 positive index and mediastinal bloadening had influence on the expression of C-MYC protein（ P〈0. 05）,the sex,primary site,symptoms,age,Ann Arbor stage and lactate dehydrogenase（ LDH） level and bone marrowinvolvement have no influence on it,there was no statistically significant difference（ P〉0. 05）. The 8 q24 chromosome breakage occurred in 6 cases（ 10%）,and the number of copies increased in 11 cases（ 18. 3%）. C-MYC gene copy number increase and C-MYC gene rupture in a total 20 cases of reactive hyperplasia of lymph nodes did not occur. Conclusion： C-MYC gene may play an important role on the development of T-LBL/ALL. It can be an independent prognosis factor.