摘要
目的了解原发结外弥漫大B细胞淋巴瘤(DLBCL)的免疫分型及其与预后的关系。方法复习94例原发结外DLBCL患者的临床及病理资料并进行随访,应用Kaplan-Meier法、Log-rank检验及Cox比例风险回归模型对临床资料、实验室检测结果进行单因素和多因素生存分析。参照Hans等的分型原则将其分为生发中心B细胞型(GCB型)和非生发中心B细胞型(non-GCB型),标记抗体包括CD20、CD10、bcl-6、MUM-1和Ki-67。结果 (1)本组患者中,以胃肠道受累为主,有39例(41.5%),其次包括鼻咽部、牙龈、腮腺、甲状腺、睾丸、卵巢、皮肤等。(2)肿瘤细胞均表达CD20抗原;CD10、bcl-6、MUM-1的阳性表达率分别为39.4%(37/94)、72.3%(68/94)、45.7%(42/94),Ki-67阳性指数25%～95%,中位数为80%。Hans分型:53.2%(50/94)为GCB型,46.8%(44/94)为non-GCB型。(3)89.4%(84/94)的患者接受化疗,66.8%(60/94)的患者接受手术。患者的2、3和5年总体生存率分别为71.3%、61.7%和36.2%,环磷酰胺+多柔比星+长春新碱+泼尼松方案(CHOP)治疗组的2、3和5年总体生存率分别为70.3%、60.8%和37.8%。GCB型2、3和5年总体生存率分别为78.0%、70.0%和48.0%,non-GCB型2、3和5年总体生存率分别为63.6%、52.3%和22.7%,差异有统计学意义(χ2=8.700,P=0.003)。结论 Hans分型、结外病变数量、IPI评分、化疗是原发结外DLBCL患者独立的预后因素。
Objective To study the immunophenotype and prognostic significance of primary extranodal diffuse large B-cell lymphoma.Methods The clinicopathologic features and follow-up data in 94 cases of primary extranodal diffuse large B-cell lymphoma were analyzed by Kaplan-Meier method,Log-rank test and Cox regression model.Immunohistochemistry was carried out using EnVision method for CD20,CD10,bcl-6,MUM-1 and Ki-67.Results Amongst the 94 cases studied,41.5% were gastrointestinal tract involved,others including nasopharynx,gingiva,parotid,thyroid,testicles,ovary,skin and so on.The percentages of tumor cells expressed CD20,CD10,bcl-6 and MUM-1 were 100%(94/94),39.4%(37/94),72.3%(68/94),45.7%(42/94),respectively.The Ki-67 index ranged from 25%to 95%(median=80%).53.2%(50/94)were GCB type and the rest 46.8%(44/94)were non-GCB type.89.4%(84/94)received chemotherapy and 66.8%(60/94)underwent surgical resection.The overall 2,3 and 5-year survival rates were 71.3%,61.7%and 36.2%,respectively.The overall 2,3 and 5-year survival rates in the CHOP therapy group were 70.3%,60.8%and 37.8%,respectively.The overall 2,3 and 5-year survival rates in GCB type were higher than non-GCB type(χ2=8.700,P=0.003).Conclusions Hans classfication,number of involved sites,international prognostic index and chemotherapy were independent prognostic factors.
出处
《中华临床医师杂志（电子版）》
CAS
2012年第17期5073-5078,共6页
Chinese Journal of Clinicians(Electronic Edition)
