CAJ | 학술논문

目的了解弥漫大B细胞淋巴瘤(DLBCL)患者的临床特点、病理学特征、免疫标记与预后的关系.方法收集147例初发DLBCL患者的临床资料,对其病理组织切片采用免疫组化二步法检测CD10、Bcl-6、MUM1、FOXP1、GCET1、CD5、Bcl-2、Ki-67的表达情况,并根据Hans分型及Choi分型进行预后分析比较.结果 ①对147例DLBCL患者的临床资料进行Kaplan-Meier单因素分析,发现Ann Arbor分期I～Ⅱ期(P=0.032)、IPI评分0～2分(P=0.001)、结外累及≤1处(P=0.014)、获得完全缓解(P=0.000)的患者总体生存更好,上述因素与预后相关；但性别、年龄、LDH、B症状、治疗方案与预后无关(P值均＞ 0.05).②127例进行免疫组化分型的患者中,根据Hans分型,生发中心B细胞样(GCB)型42例,活化B细胞样(ABC)型85例；根据Choi分型,GCB型47例,ABC型80例.Kaplan-Meier单因素分析结果显示Choi分型中GCB型和ABC型患者的3年总生存率分别为78.5％和60.9％,差异有统计学意义(P=0.047)；而Hans分型中GCB型和ABC型患者的3年总生存率分别为71.8％和79.6％,差异无统计学意义(P=0.285).③在70例R-CHOP方案治疗患者中,以Ki-67的中位数75％分组,低Ki-67组(P=0.017)和CD5表达阴性组(P=0.012)患者预后更好.且COX风险比例回归模型分析结果显示IPI评分(P=0.002)和Ki-67(P=0.019)是独立的不良预后因素.结论 Ann Arbor分期、IPI评分、结外累及、疾病缓解和Ki-67与患者预后明显相关,Choi分型较Hans分型更能体现GCB和ABC亚型在预后上的差异,ABC型与不良预后相关,同时Ki-67和IPI评分是独立的不良预后因素.
목적 료해미만대B세포림파류(DLBCL)환자적림상특점、병이학특정、면역표기여예후적관계.방법 수집147례초발DLBCL환자적림상자료,대기병리조직절편채용면역조화이보법검측CD10、Bcl-6、MUM1、FOXP1、GCET1、CD5、Bcl-2、Ki-67적표체정황,병근거Hans분형급Choi분형진행예후분석비교.결과 ①대147례DLBCL환자적림상자료진행Kaplan-Meier단인소분석,발현Ann Arbor분기I～Ⅱ기(P=0.032)、IPI평분0～2분(P=0.001)、결외루급≤1처(P=0.014)、획득완전완해(P=0.000)적환자총체생존경호,상술인소여예후상관；단성별、년령、LDH、B증상、치료방안여예후무관(P치균＞ 0.05).②127례진행면역조화분형적환자중,근거Hans분형,생발중심B세포양(GCB)형42례,활화B세포양(ABC)형85례；근거Choi분형,GCB형47례,ABC형80례.Kaplan-Meier단인소분석결과현시Choi분형중GCB형화ABC형환자적3년총생존솔분별위78.5％화60.9％,차이유통계학의의(P=0.047)；이Hans분형중GCB형화ABC형환자적3년총생존솔분별위71.8％화79.6％,차이무통계학의의(P=0.285).③재70례R-CHOP방안치료환자중,이Ki-67적중위수75％분조,저Ki-67조(P=0.017)화CD5표체음성조(P=0.012)환자예후경호.차COX풍험비례회귀모형분석결과현시IPI평분(P=0.002)화Ki-67(P=0.019)시독립적불량예후인소.결론 Ann Arbor분기、IPI평분、결외루급、질병완해화Ki-67여환자예후명현상관,Choi분형교Hans분형경능체현GCB화ABC아형재예후상적차이,ABC형여불량예후상관,동시Ki-67화IPI평분시독립적불량예후인소.
Objective To investigate the relationship between the clinical features,pathogenesis,immunophenotype,different classification models and prognosis in Chinese patients with diffuse large B-cell lymphoma(DLBCL).Methods A total of 147 patients with DLBCL who were treated with CHOP-like or R-CHOP were subjected to analysis.Standard two-step Envision method of immunohistochemical staining was used to assess the expression of CD10,Bcl-6,MUM1,FOXP1,GCET1,CD5,Bcl-2,Ki-67,then according to Hans algorithm,Choi algorithm and Molecular markers,we compared the differences of their prognosies.Results ①)Kaplan-Meier univariate analysis of the clinical data of 147 DLBCL patients found that the 3-year overall survival (OS) rates were better in early stage (P=0.032),low IPI score (P=0.001),less than one extranodal involvement (P=0.014),and complete remission (P ＜ 0.01).The prognosies had no significant differenced in terms of gender,age,LDH,B symptoms and treatment options (P value ＞ 0.05).②For Hans model,GCB group had 42 cases,the ABC group 85 cases; GCB were 47 cases,ABC 80 cases (according to Choi model).Choi model suggested GCB subtype showed much better prognosis than ABC subtype (P=0.047),while Hans model shed no statistically significant difference (P=0.285).③Ki-67 of 75％ was found to significantly discriminate patients with good or bad prognosis.In R-CHOP group at the same time,low Ki-67 (P=0.017) and CD5-negative groups (P=0.012) were better.Cox proportional hazards regression model showed that IPI score (P=0.002) and Ki-67 (P=0.019) were independent adverse prognostic factors.Conclusion The Ann Arbor stage,IPI score,extranodal involvement status and Ki-67 were significantly associated with prognosis.Compared to Hans algorithm,Choi had an advantage to predict the differente prognosis between subtypes,and ABC group had poor outcome.Finally,both Ki-67 and IPI score were independent adverse prognostic factors.