CAJ | 학술논문

目的探讨弥漫性大B细胞淋巴瘤(DLBCL)中myc基因重排和蛋白表达及其与预后的相关性.方法采用免疫组织化学EnVision法检测106例DLBCL患者肿瘤组织中CD3、CD10、CD20、bcl-6、多发性骨髓瘤原癌基因1(Mum-1)和myc蛋白的表达情况,采用荧光原位杂交(FISH)技术检测myc基因重排.结果 106例DLBCL肿瘤组织中,myc、Mum-1、CD10和bcl-6阳性率分别为70.8％、56.6％、21.7％和26.4％.106例DLBCL患者中,生发中心样(GCB)26例(24.5％),非生发中心样(non-GCB) 80例(75.5％);myc基因重排13例(12.3％),均为non-GCB型,与myc蛋白表达无关.myc基因重排的DLBCL患者预后极差,中位总生存时间和无进展生存时间分别为4.7个月和3.2个月.多因素生存分析显示,myc基因重排、ECOG评分、免疫分型和myc蛋白表达为影响DLBCL患者预后的独立因素,且myc基因重排的预后预测意义最强.结论 myc基因重排可作为评价DLBCL患者预后的生物学参考指标.myc蛋白表达受多种调控因素影响,基因重排可能为其中因素之一.
목적 탐토미만성대B세포림파류(DLBCL)중myc기인중배화단백표체급기여예후적상관성.방법 채용면역조직화학EnVision법검측106례DLBCL환자종류조직중CD3、CD10、CD20、bcl-6、다발성골수류원암기인1(Mum-1)화myc단백적표체정황,채용형광원위잡교(FISH)기술검측myc기인중배.결과 106례DLBCL종류조직중,myc、Mum-1、CD10화bcl-6양성솔분별위70.8％、56.6％、21.7％화26.4％.106례DLBCL환자중,생발중심양(GCB)26례(24.5％),비생발중심양(non-GCB) 80례(75.5％);myc기인중배13례(12.3％),균위non-GCB형,여myc단백표체무관.myc기인중배적DLBCL환자예후겁차,중위총생존시간화무진전생존시간분별위4.7개월화3.2개월.다인소생존분석현시,myc기인중배、ECOG평분、면역분형화myc단백표체위영향DLBCL환자예후적독립인소,차myc기인중배적예후예측의의최강.결론 myc기인중배가작위평개DLBCL환자예후적생물학삼고지표.myc단백표체수다충조공인소영향,기인중배가능위기중인소지일.
Objective To study the relationship between myc gene rearrangement and myc protein expression in diffuse large B cell lymphoma (DLBCL),and their correlation with prognosis.Methods One hundred and six cases of DLBCLs with follow-up data were analyzed using interphase fluorescence in situ hybridization (FISH) technique.Immunophenotyping analysis for CD20,CD3,myc,Mum-1,CD10,bcl-6 was also performed using EnVision immunohistochemistry.Results The percentages of tumor cells expressing myc,Mum-1,CD10 and bcl-6 were 70.8％,56.6％,21.7％ and 26.4％,respectively.Twenty six cases(24.5％)were of GCB type and the rest(75.5％)were of non-GCB (non germinal center) type.The myc rearrangement was identified in 13 (12.3％) of 106 cases.13 cases showed to be of non-GCB type.There was no correlation between myc rearrangement and myc protein expression.DLBCLs (n =13) with myc rearrangement showed significantly poorer overall survival (OS) and progression free survival (PFS),with a median OS and PFS time of 4.7 and 3.2 months,respectively (for OS and PFS,P ＜0.001).Multivariate analysis using Cox proportional hazard model confirmed that myc rearrangement,ECOG performance status of 2-4,immunophenotyping subgroup and myc protein were independent factors affecting the prognosis and significantly associated with the survival.However,myc rearrangement was the strongest prognostic factor.Conclusions DLBCL with myc gene rearrangement is a subgroup of non-GCB DLBCL with poor outcome.It is an independent and useful factor for prognosis in DLBCL.Expression of myc is influenced by many factors and myc rearrangement may be one of these factors.