CMYC、BCL_2、BCL_6蛋白表达与弥漫性大B细胞淋巴瘤预后关系的研究

Prognostic significance of CMYC,BCL2 and BCL6 protein expression in diffuse large B cell lymphoma

目的探讨CMYC、BCL_2与BCL_6蛋白表达与弥漫性大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)患者临床特征及预后的关系。方法采用免疫组织化学染色法检测我院于2012年1月至2014年4月收集的85例DLBCL患者病理组织标本中CMYC、BCL_2、BCL_6、CD10、MUM-1蛋白的表达情况。结果 CMYC、BCL_2、BCL_6蛋白表达阳性率分别为29.4%(25/85)、58.8%(50/85)、69.4%(59/85),其在患者年龄、性别、临床分期、原发部位、血清LDH水平、化疗方案、IPI评分、A/B症状和骨髓侵犯等临床特征之间的表达无显著差异(P>0.05)。单因素生存分析显示,CMYC阴性和BCL_2阴性患者中位OS和中位PFS均显著长于阳性患者(P<0.05),BCL_6阳性和阴性患者中位OS和中位PFS比较差异无统计学意义(P>0.05)。Cox多因素分析显示,CMYC状态可作为DLBCL患者OS和PFS的独立预测指标,差异均具有统计学意义(P<0.05)。结论 CMYC可作为预测DLBCL患者预后的独立有效指标,并可在临床进行应用。

To investigate the CMYC, BCL2 and BCL6 protein expression in diffuse large B cell lymphoma （DLBCL） relationship between clinical characteristics and prognosis of patients, in order to provide a basis for prognosis and treatment of patients with DLBCL. Methods The expression of CMYC, BCL2, BCL6, CD10 and MUM-1 proteins in 85 pathological specimens of DLBCL patients from January 2012 to April 2014 were detected by immunohistochemical staining. The expression of CMYC, BCL2／CL6 protein, clinical features, prognosis and relationship were analyzed. Results CMYC, BCL2, BCL6 protein positive rate was 29.4% （25/85）, 58.8% （50/85）, 69.4% （59/85）, and there were no statistical significantly differences in expression between clinical features in patients with clinical stage, age, sex, primary site, the level of serum LDH, chemotherapy, IPI, A/B symptoms and bone marrow involvement （ P 〉0.05）. There were no statistical significantly differences in the expression of CMYC and BCL2 among the two subtypes （ P 〉0.05）. The positive rate of BCL6 expression in type GCB patients was significantly higher than that in type non-GCB （ P 〈0.05）. Univariate analysis showed that the OS and PFS of patients with CMYC negative and BCL2 negative were significantly longer than that of patients with positive （ P 〈 0.05 ）, there were no statistical significantly differences in the median OS and median PFS between BCL6 positive and negative patients （ P 〉0.05）. Cox multivariate analysis showed that the CMYC status could be used as an independent predictor of OS and DLBCL in patients with PFS, and there were statistical significantly differences （ P 〈 0.05） . Conclusion CMYC can be used as an independent and effective index to predict the prognosis of patients with DLBCL.