Expression And Clinical Significance Of CD40in Diffuse Large B-cell Lymphoma

Diffuse large B-cell lymphoma (DLBCL) is one of the most common types ofnon-Hodgkin’s lymphoma (NHL), with a high degree of heterogeneity inxmorphology, immune phenotype, genetics and clinical presentation. It is reportedthat the immunochemotherapy of rituximab in combination with CHOP (R-CHOP) iseffective in60-70%of DLBCL patients, but there are still a portion of DLBCLpatients who have poor response and are prone to recurrence and disease progressionwith unfavorable prognosis. Presently, international Prognostic Index (IPI) is widelyused both at home and abroad to assess prognosis of DLBCL patients. However,in-depth studies have gradually revealed that patients with same IPI had differentprognosis. If we can find more effective factor to assess prognosis and recurrence toidentify patients with high risk and treat them actively, we will help improve thetreatment and prognosis. During the research of recent years, the expression of CD40on tumor cells caught great attention of scientists. It was observed that not only thestimulation of CD40molecules could act directly on the tumor cells, but the mediatedsignal could also influence the genesis and development of tumors in many ways.With regard to the expression of CD40in DLBCL, reports was rare both at home andabroad, and especially in our county, no relevant studies had been reported. In thispaper.Objective To observe the expression of CD40in DLBCL patients and to explorethe relationship of CD40with relevant clinical factors, clinicopathologiccharacteristics and prognosis, providing evidence for diagnosis and treatments.Methods The clinical data of87patients who were diagnosed as DLBCL in JilinProvince Cancer Hospital from January2008to December2012was analyzedretrospectively. Immunohistochemical methods were used to detect the expression ofCD40, Ki67, CD20, CD79a, CD3, CD5, CyclinD1, CD10, BCL-2, BCL-6, MUM-1and PAX-5. Each patient’s clinical characteristics, disease free survival and overallsurvival (OS) were recorded in detail. Finally, the data was analyzed using SPSS19.0software to discuss the expression of CD40in DLBCL patients and the relationship between CD40and clinical factors and analyze the relationship of the clinicalcharacteristics with CD40and OS.Result1. DLBCL patients with overexpression of CD40are characterized by lowage, early clinical stage, less extranodal involvement, low IPI index and lower ECOGscore. However, there is no significant correlation between gender and disease site.DLBCL patients with overexpression of CD40showed significantly higher OS thanthose without overexpression of CD40, indicating that CD40overexpression may be apredictor of prognosis.2. One-way analysis of variance showed that the prognosis ofpatients with DLBCL was closely associated with age, ECOG score, IPI index,extranodal involvement and LDH etc. Patients with age≤60, clinical stage I-II, lessthan two sites of extranodal involvement, IPI index0-2and ECOG score0-1hadbetter prognosis.3. Stratified analysis showed that CD40overexpression wassignificantly correlated with the prognosis of DLBCL when IPI index was0-2, andthat it was significantly correlated with OS of patients with DLBCL, regardless ofGCB or non-GCB, and that it was also significantly correlated with OS when CHOPregimen was used. These results indicate CD40overexpression is more predictive forthe prognosis of patients with DLBCL.Conclusion The expression of CD40is an independent indicator of prognosis, andCD40overexpression prompt good prognosis.