弥漫性大B细胞淋巴瘤3q27染色体状态和不同亚型与预后的关系

目的 从蛋白和基因水平研究弥漫性大B细胞淋巴瘤(DLBCL)的3q27染色体状态和不同亚型与预后的关系.方法 应用免疫组织化学EnVision法对有随访资料的73例DLBCL进行CD3、CD10、CD20、bcl-6、MUM-1标记,根据Hans的分类方法分为生发中心B细胞型(GCB型)和非生发中心B细胞型(non-GCB型),其中54例应用荧光原位杂交(FISH)技术检测bcl-6基因所在的3q27染色体的断裂和扩增情况.结果 73例DLBCL患者GCB型16例(21.9%),non-GCB型57例(78.1%).54例DLBCL患者中3q27染色体断裂11例(20.4%),扩增14例(25.9%).5年总体生存率GCB型(78%)高于non-GCB型(40%),差异有统计学意义(P=0.011).bcl-6阳性表达较阴性者预后好(P=0.041);3q27断裂阳性组病例总体生存率低于3q27断裂阴性组.结论 DLBCL的GCB型比non-GCB型预后好.bcl-6蛋白表达有助于DLBCL的预后判断,3q27染色体断裂阳性病例总体生存率低于3q27断裂阴性组.目前仍有必要区分DLBCL的B细胞的起源.

State of chromosome 3q27 and different subtypes of diffuse large B-cell lymphomna and their prognostic correlation

Objective To study the immunophenotypic and genetic features of diffuse large B-cell lymphomas (DLBCLs), and their relationship to prognosis. Methods Seventy-three cases of DLBCLs with follow-up date were studied by using immunohistochemistry for CD3, CD10, CD20, bcl-6 and MUM-1. The DLBCLs were classified into germinal center B cell-like (GCB) and non-germinal center B cell-like (non- GCB) subtypes according to Hans' algorithm. Fluorescence in-situ hybridization (FISH) for bcl-6 gene expression (located on chromosome 3q27) was performed on paraffin-embedded tissues of 54 cases. Results In the 73 cases studied, 16 cases (21.9%) belonged to GCB subtype and 57 cases (78.1%) belonged to non-GCB subtype. Breakage of 3q27 was detected in 11 of the 54 cases (20.4%) and proliferation was detected in 14 cases (25.9%). The five-year overall survival rate of GCB subtype was significantly higher than that of non-GCB subtype (78% versus 40%, P = 0.011). The bcl-6-pesitive cases had a better clinical outcome than that of the bcl-6-negative cases (P = 0.041). Breakage of 3q27 predicted a worse overall survival Conclusions The current study shows that the prognosis of GCB subtype of DLBCLs is better than that of non-GCB subtype. The expression of bcl-6 protein predicts a better clinical outcome, while the breakage of 3q27 predicts a worse overall survival.