弥漫大B细胞淋巴瘤病理组织Myc蛋白表达与治疗的相关性

Myc expression in diffuse large B cell lymphoma pathologic tissue and the correlation with the treatment

目的观察弥漫大B细胞淋巴瘤患者病理组织Myc蛋白表达情况,分析其与沙利度胺治疗疗效及患者预后的相关性。方法分析本院收治的84例弥漫大B细胞患者的临床资料,所有患者给予化疗联合沙利度胺(口服,起始剂量100 mg·d-1,每周增加50 mg·d-1,直至300~400 mg·d-1)治疗,治疗2个疗程。以免疫组化法检测治疗前患者病理组织Myc表达情况,分析其与患者临床病理特征及近远期临床疗效的相关性。结果84例患者病理组织中Myc阳性表达率为76.19%,疾病控制率(DCR)为79.76%。与Myc阳性组比,Myc阴性组完全缓解(CR)+部分缓解(PR)患者比例、国际预后指数(IPI)评分升高、无进展生存期(PFS)延长(P<0.05);Ann Arbor分期以Ⅲ~Ⅳ期、国际预后指数评分为3~5分及非生发中心来源(non-GCB)亚型患者病理组织Myc阳性表达率分别显著高于Ann Arbor分期Ⅰ~Ⅱ期、IPI评分为0~2分及生发中心来源(GCB)亚型患者(P<0.05);Spearman相关性分析显示,Myc蛋白阳性表达与患者CR+PR比例、IPI评分及PFS均显著负相关(r=-0.415;r=-0.507;r=-0.492,P<0.05)。结论Myc在弥漫大B细胞淋巴瘤患者病理组织中高表达,且其阳性表达与患者沙利度胺治疗的近远期疗效均明显负相关,可作为弥漫大B细胞淋巴瘤患者预后的评估指标。

Objective To explore Myc expression in diffuse large B cell lymphoma pathologic tissue and analyse the correlation with clinical effect of thalidomide treatment and patients prognosis.Methods The clinical data of 84 cases diffuse large B cell lymphoma patients in our hospital were analysed.All patients were treated with ICE chemotherapy combined with thalidomide(oral,the starting dose with 100 mg·d-1,increased weekly 50 mg·d-1,until 300-400 mg·d-1),all patients were treated for 2 courses.The Myc expression in pathological tissue was detected by immunohistochemical method,the correlation with clinical pathological characteristics and recent and long-term clinical efficacy was analyzed.Results The Myc positive expression rate in the pathologic tissue among the 84 patients was 76.19%,disease control rate(DCR)was 79.76%.Compared with Myc positive group,the proportion of complete remissioon(CR)+partial remissioon(PR)patients,international prognostic index(IPI)score in Myc negative group were increased,the progression free survival(PFS)in Myc negative group was extended(P<0.05).The proportion of patient with Myc protein positive of patients with AnnArbor staging withⅢ-Ⅳ,IPI score with 3-5 scores and non-germinal center-derived B-cell(non-GCB)were higher than those patients with AnnArbor staging withⅠ-Ⅱ,IPI score with 0-2 scores and germinal center-derived B-cell(GCB)(P<0.05).Spearman correlation analysis showed that,the Myc positive expression had significant negative correlation with proportion of CR+PR patients,IPI score and PFS(r=-0.415;r=-0.507;r=-0.492,P<0.05).Conclusion Myc in diffuse large B cell lymphoma pathologic tissue shows high expression,and Myc positive expression has negative correlation with recent and long-term clinical efficacy of patients with thalidomide treatment,which can act as the prognosis evaluation index of the chemotherapy curative effect of diffuse large B cell lymphoma patients.