| Objective Collected DLBCL clinical data in the General Hospital of Ningxia Medical University from nearly 10 years, and detectedthe expression of MYC, BCL- 2, BCL- 6 in DLBCL patients by immunohistochemical method. Systematicly understanded the whole situation,the clinical pathological characteristics, treatment and prognosisof MYC, BCL- 2, the BCL- 6 protein co-expression of DLBCL patients in our hospital in recent 10 years, and exploring the correlation between the expression of double and triple expression with its clinical pathological characteristics and prognosis, in order to provide useful information to predict prognosis for DLBCLpatients, help clinical physicians to make individualized treatment plan for patients, improve the curative effect and the survival to lay the foundation.Method Collected the clinical data of 183 patients with DLBCL by histologic diagnosis in the General Hospital of Ningxia Medical University from December 31, 2014 to jan 01, 2005, then selected 165 eligible cases.Detected theexpression of C- MYC, BCL- 2, the BCL- 6 in DLBCL patients with immunohistochemical method, then analyzed the relationship between the expression of C- MYC, BCL- 2, the BCL- 6 with age, sex, nationality, B symptoms, hepatitis B virus infection symptoms, starting position, number of lymph nodes outside of invasion, IPI score, ECOG score, tumor size, clinical stage, liver, spleen and bone marrow infiltration, LDH level, Ki67 index, pathological classification by chi-square statistic, and explained the C- MYC, BCL- 2, the BCL- 6 co-expression with clinical pathological characteristics, treatment response and survival in DLBCL patients.Results 1. The general situation:(1) Clinical features: in 165 patients with DLBCL, median age was 61 years, >60 years of age accounted for 52.1%(86/165); The sex ratio was 1.32 :1; The Han nationality accounted for 86.1%(142/165), the Hui nationality was 12.1%(20/165), other national accounted for 1.8%(3/165); Hepatitis B Virus infection accounted for 27.9%(46/165); Had B symptoms accounted for 29.7%(49/165); starting position was located the lymph node accounted for 47.3%(78/165), outside of the lymph node accounted for 52.7%(87/165), which gastrointestinal tract accounted for 40.2%(35/87), waldeyer's ring was 25.3%(22/87), sinus and nasal cavity, bone, breast, skin, testicular, spleen and thyroid were rare; The number of lymph nodes outside of invasion ? 1 accounted for 79.4%(131/165), > 1 accounted for 20.6%(34/165);IPI score 0 to 2 accounted for 55.2%(91/165), 3-5 accounted for 44.8%(74/165); ECOG score 0-1 accounted for 77.6%(128/165), 2-4 was 22.4%(37/165); Tumor size < 7.5 cm accounted for 69.1%(114/165),?7.5 cm accounted for 30.9%(51/165); Increased LDH accounted for 41.2%(68/165); Clinical staging?-?period accounted for 56.4%(93/165), ?-?period accounted for 43.6%(72/165);Liver infiltration accounted for 9.7%(16/165), spleen infiltration accounted for 10.3%(17/165), bone marrow infiltration accounted for 12.7%(21/165).(2) Pathological characteristics: GCB type accounted for 41.8%(69/165), non- GCB accounted for 58.2%(96/165); Ki67 index ?50% accounted for 84.8%(140/165), <50% accounted for 15.2%(25/165); C- MYC protein positive expression accounted for 32.7%(54/165), negative expression was 67.3%(111/165); The BCL- 2 protein positive expression accounted for 60.0%(99/165), negative expression was 40.0%(66/165); The BCL- 6 protein positive expression accounted for 50.3%(83/165), negative expression was 49.7%(82/165). 2. The chi-square statistic analysis, the expression of C- MYC in DLBCL patients correlated with B symptoms, starting area, number of lymph nodes outside of invasion, IPI score, tumor size, clinical stage, liver and bone marrow infiltration, LDH level and pathological classification, but not age, sex, nationality, hepatitis B virus(HBV) infection, ECOG score, spleen infiltration, Ki- 67. The expression of BCL- 2, BCL- 6 has no relevance with age, sex, nationality, hepatitis B virus infection symptoms, B symptoms, starting position, number of lymph nodes outside of invasion, IPI score, ECOG score, tumor size, clinical stage, liver, spleen and bone marrow infiltration, LDH level, Ki-67.The BCL- 6 had correlation with pathologic classification. 3. C- MYC, BCL- 2, the BCL- 6 co-expression in DLBCL patients: C- MYC/BCL- 2 co-expression 28 cases, C-MYC/BCL- 6 co-expression 7 cases, C- MYC/BCL- 2 / BCL- 6 co-expression 4 cases, a total of 39 cases, accounted for 23.6% of whole group(39/165); the median age was 65 years, >60 years of age accounted for 64.1%(25/39); The sex ratio was 1.29 :1; The Han nationality accounts for 94.9%(37/39), the Hui nationality was 5.1%(2/39); Hepatitis B virus infection accounted for 30.8%(12/39); Group B symptoms accounted for 64.1%(25/39); Starting position was located the lymph node accounted for 41.0%(16/39), outside of the lymph node accounted for 5 59.0%(23/39); The number of lymph nodes outside of invasion?1 accounted for 46.2%(18/39), > 1 was 53.8%(21/39); IPI score 0 to 2 points, 25.6%(10/39), 3-5 accounted for 74.4%(29/39); ECOG score 0-1 accounted for 69.2%(27/39), 2-4 accounted for 30.8%(12/39); Tumor size < 7.5 cm accounted for 46.2%(18/39), ?7.5 cm accounted for 53.8%(21/39); Increased LDH levels accounted for 87.2%(37/39), normal accounted for 12.8%(5/39); Clinical staging ?-? period accounted for 30.8%(12/39), ?-? accounted for 69.2%(27/39); The liver infiltration accounted for 28.2%(11/39); The spleen infiltration accounted for 17.9%(7/39); Bone marrow infiltration accounted for 30.8%(12/39); Ki67 index ?50% accounted for 89.7%(35/39), < 50% accounted for 10.3%(4/39); GCB type accounted for 66.7%(26/39), non- GCB accounted for 33.3%(13/39). 4. MYC, BCL- 2, the BCL- 6 protein co-expression correlated with group B symptoms, starting position, number of lymph nodes outside of invasion, IPI score, tumor size, clinical stage, liver and bone marrow infiltration, LDH levels and pathological classification, but not age, gender, nationality, hepatitis B virus infection, ECOG score, spleen infiltration and Ki67 index by chi-square statistic analysis. 5. The whole group of patients with DLBCL median survival time was 45.0 months; C- MYC protein expression positive group and negative group median survival time were 16.0 months and 60.0 months respectively; The BCL-2 protein expression positive group and negative group the median survival time were 48.0 months and 51.0 months respectively; The BCL- 6 protein expression positive group and negative group the median survival time were 57.0 months and 43.0 months respectively. 39 patients double or triple expression median survival time was 15.0 months, 28 cases of C-MYC/BCL- 2 expression patients 's median survival time was 16.0 months. 7 cases of C-MYC/BCL- 6 expression patients' s median survival time was 13.0 months; 4 cases of C-MYC/BCL- 2 / BCL- 6 expression patients' s median survival time was 3.0 months. 6. May 23 factors affecting the prognosis of patients with DLBCL by COX survival model of multi-factor analysis hint: starting position, The number of lymph nodes outside of invasion, IPI score, ECOG score, clinical stage, tumor size, liver infiltration,bone marrow infiltration, C- MYC protein expression, C- MYC/BCL- 2/BCL- 6 protein co-expression, pathological classification, in the near future curative effect was affected in patients with DLBCL independent prognostic factors for survival.Conclusion 1. C- MYC protein expression and C- C MYC, BCL- 2, BCL- 6 protein co-expression could be used as indicators to judge the prognosis of DLBCL patients,?BCL- 2, the BCL- 6 protein expression was not alone as an independent index affect the prognosis of patients with DLBCL. 2. C- MYC, BCL- 2, the BCL- 6 protein co-expression patients were starting position was located outside of the lymph node, late clinical stage to, more multiple organ infiltration, liver and bone marrow infiltration, high IPI score high, bigger mass,increased LDH level, GCB type. 3. C- MYC, BCL- 2, the BCL- 6 protein co-expression in DLBCL patients were poor treatment effect with standard chemotherapy treatment,and short survival period.The best treatment still need to be forward-looking research and exploration. |
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