MYC、BCL-2和BCL-6检测在弥漫性大B细胞淋巴瘤患者预后判断中的价值

Value of MYC, BCL-2 and BCL-6 for Evaluation of Prognosis in Patients with Diffuse Large B Cell Lymphoma

目的:分析BCL-2、BCL-6和MYC检测在弥漫性大B细胞淋巴瘤(DLBCL)患者中预后判断中的价值。方法:收集2012年3月至2015年3月本院收治的DLBCL患者163例患者的淋巴瘤组织标本,采用免疫组织化学方法检测患者BCL-2、BCL-6和MYC的表达水平,并用间期荧光原位杂交技术对IGH/BCL-2融合、BCL-6基因断裂及MYC基因断裂进行检测,进一步分析BCL-2、BCL-6和MYC表达水平与DLBCL患者临床病理特征及预后的相关性。结果:MYC、BCL-2及BCL-6均呈现棕黄色或棕褐色的阳性信号,其中MYC主要于细胞膜上呈现阳性表达,BCL-2主要于细胞质及局部细胞膜上呈现阳性表达,BCL-6主要于细胞核上呈现阳性表达。ECOG体能状态评分≥2分者BCL-2表达水平较<2分者明显升高,且免疫亚型为CD5^+、生发中心B细胞样(GCB)者BCL-2表达水平较非GCB者明显升高(P<0.05);国际预后指数(IPI)评分为3-5者MYC表达水平较0-2分者明显升高(P<0.05);免疫亚型为CD5^+、GCB者BCL-6表达水平较非GCB者明显降低(P<0.05)。经Cox多变量分析结果发现,BCL-2、BCL-6和MYC的表达水平与DLBCL患者总生存期和无进展生存期均存在显著关系(P<0.05)。结论:BCL-2、BCL-6和MYC作为重要的分子标志物,在评估DLBCL患者预后中具有较高的判断价值。

Objective:To analyze the prognostic value of BCL-2,BCL-6 and MYC in patients with diffuse large B cell lymphoma(DLBCL).Methods:One hundred and sixty three cases of DLBCL in our hospital from March 2012 to March 2015 were selected.The specimens of lymphoma tissue of patients were collected.The expression of BCL-2,BCL-6 and MYC was detected by immunohistochemical method.The fusion of IGH/BCL-2,the gene breakage of BCL-6 and MYC were detected by interphase fluorescence in situ hybridization.The correlation of the expression levels of BCL-2,BCL-6 and MYC with the clinicopathological features and prognosis in the patients with DLBCL was further analyzed.Results:MYC,BCL-2 and BCL-6 showed pale brown or reddish brown positive signals,among them MYC mainly positively expressed on the cell membrane,and BCL-2 mainly expressed on the cytoplasm and local cell membrane,and BCL-6 mainly expressed in the nucleus.The expression level of BCL-2 in ECOG physical status score 2 was higher than that in patients with<2 scores,and the expression level of BCL-2 in CD5^+ and germinal center B-cell-like(GCB)was significantly higher than that in patients with non-GCB(P<0.05),and the international prognostic index(IPI)for 3-5 scores at the MYC expression level was significantly higher than that of the 0-2 score(P<0.05);the expression level of BCL-6 in immune subtype CD5^+ and GCB was significantly lower than that in non-GCB(P<0.05).The results of Cox multivariate analysis showed that the expression level of BCL-2,BCL-6 and MYC significant correlate with the overall survival and progression-free survival(P<0.05)of the patients with DLBCL.Conclusion:BCL-2,BCL-6 and MYC as important molecular markers are of high value for evaluating the prognosis of patients with DLBCL.