| BACKGROUND & OBJECTIVESDiffuse Large B-cell Lymphoma(DLBCL) and Follicular Lymphoma(FL) are both Non-Hodgkin's Lymphoma(NHL) with different invasiveness.And marked heterogeneity in outcome is observed in both of them.They are characterized by its clinical heterogeneity and it is believed to be closely related with the microenvironment of lymphoma. CD68 is the marker of macrophage surface antigen. Tumor Associated Macrophages (TAM) are the main component of the tumor matrix cells.They excrete immunoregulational factors to achieve the interaction between tumor cells or other cells with themselves and to promote the growth and metastasis of tumor.Consequently, by detecting the expression of CD68 and the cell factors they excreted, we may identify the high risk DLBCL and FL patients for intensive therapies and improve the survival further. In this study, we employed the immunohistochemistry method to detect the quantity of TAM, express of IL-6 and IL-8 in DLBCL and FL. Then we analyzed its relationship with patients'clinical characteristics, response rate and survival.METHODS68 consecutive and untreated cases of DLBCL and 39 cases of FL diagnosed in the first affiliated hospital of Anhui Medical University from January 2000 to December 2008 were enrolled in this study. Immunohistochemistry method(S-P method) was applied to detect the expression of CD68, IL-6 and IL-8 on the selected cases. We evaluate the degree of expression. The relationship between expression of CD68, IL-6, IL-8 and treatment response and survival were retrospectively analyzed with SPSS 13.0 software pack.RESULTSAccording to the quantity of positively stained macrophages, 39 cases (57.4%) were categorized as low quantity and 29 cases (42.6%) as high quantity in DLBCL cases, while 32 cases (82.1%) were categorized as low quantity and 7 cases (17.9%) as high quantity in FL cases. The study showed that there is no statistically significance between the quantity of positively stained macrophages and the response rate of DLBCL patients(P>0.05) in DLBCL cases.However, the CR rate of FL patients with low quantity was superior to those with high quantity (P<0.05). The median survival time(MS) of patients with low quantity of TAM and high quantity were 36 months and 17 months respectively.( P=0.000).Furthermore, accrording to the expression of positively stained cells with IL-6, 21 cases (30.9%) were categorized as negative expression and 47 cases (69.1%) as positive expression in DLBCL cases, while 23 cases (59.0%) were categorized as negative expression and 16 cass (41.0%) as positive expression in FL cases. The study showed that there is no statistically significance between the quantity of TAM and the expression of cells with IL-6 (P>0.05) both in DLBCL and FL cases, which is absolutely opposite between TAM quantity and IL-8 expression(P<0.05).As indicated by univariate analysis, the OS was significantly worse for patients with high quantity of TAM and IL-8. A multivariate analysis disclosed that IPI score, TAM quantity level were all associated with patients'OS. These results suggested that TAM quantity level and IPI score are independent prognostic factors for DLBCL.CONCLUSION1. Up-regulation of TAM quantity was confirmed both in DLBCL and FL, especially in DLBCL, which possibly indicated the malignancy of tumor.2. TAM quantity is negatively correlated to treatment response of FL patients. The CR rate is lower in patients with hign TAM quantity than in those with low quantity. 3. High quantity of TAM is associated with poor prognosis of DLBCL. The MS of high quantity patients was significantly lower than the MS of low quantity patients.4. High quantity of TAM is associated with the positive expression of cells with IL-8, which indicated the important function during the interaction between TAM and tumor cell.5. IPI score and TAM quantity are independent prognostic factors for DLBCL.6. The clinical value of LAM, IL-6, IL-8 in DLBCL and FL is worthy of further prospective clinical investigations. |
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