C-myc、Bcl-2基因在弥漫性大B细胞淋巴瘤中的表达及临床意义

Expression and clinical significance of C-myc and Bcl-2 genes in diffuse large B-cell lymphoma

目的探讨B细胞淋巴瘤-2基因(Bcl-2)、原癌基因C-myc在弥漫性大B细胞淋巴瘤(DLBCL)中的表达及其临床意义。方法回顾性分析2015年1月至2018年1月南方医科大学顺德医院收治的63例DLBCL患者临床资料。采用荧光原位杂交法检测患者石蜡组织标本C-myc、Bcl-2基因表达情况。分析DLBCL患者C-myc、Bcl-2基因共异常与临床病理参数的关联,采用Cox回归模型分析影响DLBCL患者预后的危险因素。结果 63例DLBCL患者中,C-myc基因异常21例(33.33%),Bcl-2基因异常32例(50.79%),C-myc、Bcl-2基因共异常17例(26.98%),C-myc、Bcl-2基因非共异常46例(73.02%)。DLBCL患者C-myc、Bcl-2基因共异常者临床分期Ⅲ~Ⅳ期、国际预后指数(IPI)评分3~4分的患者比率(82.35%、64.17%)显著高于C-myc、Bcl-2非共异常者(39.13%、28.26%),差异有统计学意义(P <0.05),而2组基因异常部位、病理分型、B症状的患者比率比较,差异无统计学意义(P> 0.05)。Bcl-2基因异常、C-myc、Bcl-2基因共异常阳性、临床分期高、有B症状、年龄大、IPI评分高是影响DLBCL患者总生存期的单因素(P <0.05);Bcl-2基因异常、C-myc、Bcl-2基因共异常阳性、临床分期高、有B症状、年龄大、IPI评分高是影响DLBCL患者总生存期的独立危险因素(P <0.05)。结论 DLBCL患者C-myc、Bcl-2基因共异常与临床病理参数有一定关联,可辅助指导临床治疗,Bcl-2基因异常、C-myc、Bcl-2基因共异常阳性是影响DLBCL患者预后的独立危险因素。

Objective To investigate the expression and clinical significance of C-myc and B cell lymphoma/leukemia-2 gene(Bcl-2)genes in diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 63 DLBCL patients in Shunde Hospital of Southern Medical University from January 2015 to January 2018 were retrospectively analyzed.Fluorescence in situ hybridization was used to detect the expression of C-myc and Bcl-2 genes in paraffin tissue samples.The correlation between co-abnormalities of C-myc and Bcl-2 genes and clinicopathological parameters in DLBCL patients was analyzed,and the risk factors affecting prognosis of DLBCL patients were analyzed using Cox regression model.Results Among the 63 DLBCL patients,there were 21 cases(33.33%)with abnormal C-myc gene,32 cases(50.79%)with abnormal Bcl-2 gene,17 cases(26.98%)with abnormal C-myc and Bcl-2 gene,and 46 cases(73.02%)with non-abnormal C-myc and Bcl-2 gene.The proportion of patients with C-myc and Bcl-2 gene abnormalities in DLBCL patients with clinical stagesⅢtoⅣand IPI 3 to 4 scores(82.35%,64.17%)was significantly higher than that of patients with C-myc and Bcl-2 non-common abnormalities(39.13%,28.26%),the difference was statistically significant(P<0.05),and there was no statistically significant difference between the two groups of patients with genetic abnormality,pathological type,and B symptoms(P>0.05).Abnormalities of Bcl-2 gene,positive co-abnormality of C-myc and Bcl-2 gene,high clinical stage,B symptoms,advanced age,and high IPI score were the single factors affecting OS of DLBCL patients(P<0.05).Abnormalities of Bcl-2 gene,positive co-abnormality of C-myc and Bcl-2 gene,high clinical stage,B symptoms,advanced age,and high IPI score were independent risk factors affecting OS of DLBCL patients(P<0.05).Conclusion Co-abnormality of C-myc and Bcl-2 genes in DLBCL patients is correlated with clinicopathological parameters,moreover,abnormalities of Bcl-2 genes,positive co-abnormality of C-myc and Bcl-2 genes are independent risk factors affecting the prognosis of DLBCL patients.