弥漫性大B细胞淋巴瘤预后相关因素的研究

Abstract

目的探讨国人弥漫性大B细胞淋巴瘤(DLBCL)临床病理学特点,细胞起源及增殖活性与预后的关系.方法选用60例DLBCL患者,使用链霉素亲生物素-过氧化物酶连接法(SP法)进行CD45RO、CD3、CD20、CD79a、CD45RA,Ki-67、p53和bcl-6石蜡切片免疫组化染色,全部病例均有国际预后指数(IPI)及随访结果.结果 60例中男女比例为1.73∶ 1.平均年龄53.1岁.累及淋巴结32例(53.3%),结外以胃肠和扁桃体最为多见.全部病例随访时间最长达108个月.死亡23例(38.3%),其中16例在诊断后1年内死亡(69.6%).IPI分组与预后明显相关,IPI低者预后明显好于IPI高者(P=0.0102).Ki-67、p53、bcl-6蛋白在DLBCL中有一定表达,分别为90.6%(48/53), 56.5%(26/46), 51.2%(21/41),且p53与预后无明显统计学关系(P=0.5948);bcl-6与预后有高度相关性(P=0.0049);结合IPI分组,bcl-6与预后的关系不甚明确.结论国人DLBCL临床病理学特点与西方相近.属高度侵袭性肿瘤,1年内为死亡高发时段.IPI可以用于DLBCL预后判断.p53与预后无关,bcl-6与预后有一定相关性.

To study the correlation between clinical prognosis and clinicopathologic features, origin and cell proliferous index of diffuse large B-cell lymphoma (DLBCL) in China.The data of 60 cases of DLBCL were collected with the study of international prognostic index (IPI) and the follow-up results. Immunohistochemistry stain was used to check the expression of CD(45)RO, CD(3), CD(20), CD(79)a, CD(45)RA, Ki-67, p53 and bcl-6.The ratio of male to female is 1.73 and the average age is 53.1. In 53.3% cases lymph node were involved (32/60), gastric intestinal tract and tonsil were the most common extranodal sites of involvement. 23 patients 38.3% died during follow-up, the longest survival period lasting 108 months.16 died in the first year after establishment of diagnosis (16/23, 69.6%). IPI is an independent prognostic index; the lower the index, the better the prognosis (P = 0.0102). Positive incidence of CD(20), CD(79)a and CD(45)RA was 91.5%, 73.7% and 58.3%. Ki-67, p53, bcl-6 were expressed in some cases (48/53, 90.6%; 26/46, 56.5%; 21/41, 51.2%). The expression of bcl-6 protein was somewhat related with prognosis (P = 0.0049), but the expression of p53 was not (P = 0.5948).The clinicopathologic features of DLBCL are similar in the East and the West. It is highly aggressive tumor. Most of the cases died in the first year after establishment of diagnosis. IPI can be used to predict the clinical outcome. The expression of bcl-6 protein was somewhat related with clinical prognosis, but that of p53 was not.