髓细胞白血病-1在弥漫性大B细胞淋巴瘤中的表达及临床意义

Expression of myeloid cell leukemia-1 in diffuse large B cell lymphoma and its clinical significance

目的:检测髓细胞白血病-1(Mcl-1)在弥漫大B细胞淋巴瘤(DLBCL)中的表达,分析Mcl-1的表达在DLBCL中的临床意义。方法:免疫组织化学染色检测43例DLBCL患者的淋巴结石蜡病理标本的Mcl-1表达,所有患者均接受6~8个疗程R-CHOP方案免疫组织化疗,根据2014版Lugano评效标准,疗效达完全缓解(CR)或部分缓解(PR)且1年内无复发者为初始治疗有效组(26例);疗效为疾病稳定(SD)、疾病进展(PD),或曾达到CR或PR,但在缓解后1年内复发者为初始治疗无效组(17例)。分析Mcl-1表达与DLBCL患者临床特征的相关性以及其在初始治疗有效组和无效组之间是否存在差别。结果:Mcl-1阳性率为58.1%(25/43),其表达与患者性别、年龄、有无B症状等临床特征均无相关性(P>0.05);Mcl-1在初始治疗有效组阳性率为38.5%(10/26),无效组阳性率为88.2%(15/17),两组之间Mcl-1表达差异有统计学意义(P<0.05)。Mcl-1表达阳性组对初始治疗无效的概率是阴性组的15.625倍,B淋巴细胞瘤-2基因(Bcl-2)的表达作为预测治疗反应因素的假设不成立。Mcl-1和Bcl-2联合预测模型的效果要优于Mcl-1或Bcl-2表达的单独预测模型。结论:Mcl-1阳性与否可作为对初始治疗反应不佳的预测因素,Bcl-2和Mcl-1共表达是DLBCL患者一种理想的独立预后因素。

Objective: To detect the expression of Mcl-1 in diffuse large B cell lymphoma(DLBCL)and analyze the clinical significance of the expression of Mcl-1 in DLBCL.Methods: Immunohistochemical staining was used to detect the expression of Mcl-1 in paraffin pathological specimens of lymph nodes of 43 patients with DLBCL.All patients received 6-8 courses of R-CHOP regimen immunochemotherapy.According to the Lugano 2014 criteria,those who achieved CR or PR efficacy and had no relapse within 1 year were defined as the initial treatment effective group(26 cases);Patients with efficacy of SD,PD,or those who had achieved CR or PR,but relapsed within 1 year were defined as the initial treatment ineffective group(17 cases).The correlation between Mcl-1 expression and clinical characteristics of DLBCL patients,as well as whether there was a difference between the treatment effective group and the ineffective group was analyzed.Results: The positive rate of Mcl-1 was 58.1%,there was no correlation between the expression of Mcl-1 and the patient's gender,age and the presence or absence of symptoms of B etc(P>0.05).After the initial immunochemotherapy,the positive rate of Mcl-1 was 38.5%(10/26)in the effective group and 88.2%(15/17)in the ineffective group(P<0.05).The probability that the group of positive Mcl-1 expression had no response to the initial immunochemotherapy was 15.625 times that of the negative group,the hypothesis that Bcl-2 expression was a predictor of therapeutic response was not valid.The effect of the combined prediction model of Mcl-1 and Bcl-2 was better than that of the single prediction model of Mcl-1 or Bcl-2.Conclusion: The expression of Mcl-1 could be used as a predictor of DLBCL's no response to initial immunochemotherapy.As an independent factor of poor prognosis,coexpression of Bcl-2 and Mcl-1 could be a rational choice.