The Correlation Of Bcl-2, C-myc And DLBCL Subtypes, Clinical Prognosis And Its Significance

Objective Study of Bcl-2, C-myc protein expression and Bcl-2/IgH fusion gene and C-myc gene amplification in the diffuse large B cell lymphoma (DLBCL) cases, then, analyzed statistically combined with molecular subtypes , clinical factors and prognosis in order to identify Bcl-2, C-myc and DLBCL subtypes, clinical prognosis and its significance.Methods 1.Collected and screened 70 cases of untreated DLBCL specimens with complete clinical data, and use Envision two-steps immunohistochemical to detect LCA, CD45RO, CD3, CD20 and other proteins, to determine the target cells are tumor cells derived from the B cell .2.Use immunohistochemical to detect the expressions of CD10, Bcl-6, MUM-1 protein, and according to the algorithm of Hans etal. to subdivide DLBCL into germinal center B cell type (GCB type) and non-germinal center B cell type (non-GCB type) groups.3.Follow-up visited and record the living conditions of all patients.4. Use immunohistochemical to detect the expression of Bcl-2 and C-myc protein, Real-time PCR to detect Bcl-2/IgH fusion gene and C-myc gene amplification conditions, and statistical correlation analysis associated clinical factors and clinical outcome .Results 1. In the 70 cases studied, 25 cases(35.7%)belonged to GCB subtype and 45 cases (64.3%)belonged to non-GCB subtype. And the overall survival of GCB subtype was significantly higher than that of non-GCB subtype (P=0.027).2. The expression rate of Bcl-2 proteins in DLBCL was 67.1% (47cases), and the survival rates between Bcl-2 protein positive and negative patients were no have significant differences (P=0.054), but in the non-GCB subtype the survival rates of the Bcl-2 protein negative patients was lower than that in Bcl-2 protein positive patients (P=0.027). In addition, Real-time PCR detected 12 patients with Bcl-2/IgH gene fusion, these cases all belonged to the GCB subtype, accounting for 48.0% of all the GCB-type, Bcl-2/IgH gene fusion associated with AnnArbor stage Statistically significant (P=0.003). TheΔCt values of Bcl-2/IgH fusion gene in theⅢ～ⅣAnn Arbor stage patient's body to be significantly lower than that ofⅠ～Ⅱpatients (P=0.008), and Bcl-2/IgH gene fusion-positive cases had a poor prognosis than that of the Bcl-2/IgH gene fusion-negative cases (P=0.020). 3. The expression rate of C-myc proteins in DLBCL was 87.1%(61 cases), the survival rates between nucleus positive group and cytoplasm positive group were significantly different (P=0.036), cytoplasm positive group had the low survival rate. C-myc gene amplification was detected in 19 of the 70 cases(27.1%),C-myc gene amplification was significantly correlated to C-myc protein expression region(P=0.001) but no correlation with the survival rate.In addition, Real-time PCR showed that theΔCt values of C-myc gene in theⅢ～ⅣAnn Arbor stage patient's tumour was lower than that inⅠ～Ⅱpatients (P=0.012), and theΔCt value of C-myc nucleus-positive patients was significantly higher than that of cytoplasm-positive patients (P=0.007).Conclusion 1.The prognosis of GCB subtype of DLBCLs is better than that of non-GCB subtype, subtyping of DLBCL were favorable prognosis and treatment options.2. Detection of Bcl-2 protein expression in tne non-GCB subtypes and detect Bcl-2/IgH fusion gene of the GCB subtype, to further improve the prognosis and clinical staging, contribute to the development of rational treatment of patients.3.The region of C-myc protein expression and C-myc gene amplification detected all contribute to the clinical staging.