| Objective Diffuse large B cell lymphoma(DLBCL)is a kind of malignant tumor of non Hodgkin's lymphoma,which is the highest proportion in NHL.Large scale epidemiological studies have shown that HBV infection may be a risk factor for NHL,especially in diffuse large B cell lymphoma.Although a large number of studies have confirmed the epidemiological correlation between HBV infection and NHL,there are few studies on the pathogenesis,clinical features and prognosis of HBV associated lymphoma.Therefore,this article will investigate the clinical features,BCL-2,CMYC protein expression and prognosis of patients with Hepatitis B virus-associated diffuse large B-cell lymphoma(DLBCL).Methods A retrospective study was used to analyse 94 diagnosed DLBCL patients clinical data from January 2009 to December 2014 in the First Affiliated Hospital of Medical University.Using immunohistochemistry method to detect the expression of BCL-2 and CMYC protein in paraffin sections of tumor tissues,and to analyze the clinical features,protein expression and prognosis of patients with Hepatitis B virus-associated DLBCL.Results(1)The rate of HBV infection in the 94 DLBCL patients was 27.66%,significantly higher than the general population(7.18%);compared with Hbs Ag-negative DLBCL,Hbs Ag-Positive DLBCL displayed more advanced disease(III-IV:73.1% VS48.5,P=0.032),higher international Prognostic Index(IPI)(>=3:46.2% VS 25.0%,P=0.047)and more frequent involvement of spleen(38.5% VS 16.2%,P=0.02),there is no significant difference on the gender distribution,age,immunological subtype and treatment between the two groups;(2)The expression of BCL-2 protein in Hbs Ag(+)group was significantly higher than that in Hbs Ag(-)group(84.6% vs 42.3%,P =0.018),and there was significant difference between the two groups.The expression of CMYC protein in Hbs Ag(+)group and Hbs Ag(-)group were 84.6% and 42.3%,there was no significant difference between the two groups(P = 0.444).About BCL-2 /CMYC protein "double expression" : there was no significant difference between the Hbs Ag(+)group and Hbs Ag(-)group(38.5% VS 25.0%,P=0.197)(3)The 2 years OS and PFS in the Hbs Ag(+)group DLBCL patients were significantly lower than the Hbs Ag(-)group(OS:52.4%% VS 76.6%%,P=0.043;PFS:37.8%VS,69.4%,P=0.042).The 2 years OS and PFS In CMYC protein positive group were lower than those in CMYC protein negative group(OS:46.7% VS 82.4%,P=0.001;PFS:37.8%VS,75.1%,P=0.000).The 2 years OS and PFS In the BCL-2 protein positive group were lower than those in BCL-2 protein negative group(OS:61.5% VS 87%,P=0.041;PFS:53.4% VS,,P=0.021).The 2 years OS and PFS in BCL-2/CMYC protein co expression group were lower than those in BCL-2/CMYC protein non co expression group(OS:41.0% VS,P=0.000,PFS:22.6%,VS,,P=0.000).The 2 years OS and PFS in high-risk group were lower than those in low risk group(OS:45.0% VS 81.8%,P=0.041;PFS:28.6% VS,,P=0.000).Univariate survival analysis showed that hepatitis B virus infection,BCL-2positive,CMYC positive,CMYC/ BCL-2 “double expression”,IPI high-risk group were associated with unfavorable prognostic of Overall survival time(OS)and Progression free survival(PFS);Cox multivariate analysis showed that CMYC/ BCL-2“double expression”,IPI high-risk group were independent adverse prognostic factors for OS and PFS.Conclusion: HBV infection in patients with DLBCL was significantly higher than the general population,HBV may play a role in the pathogenesis of DLBCL.2.The HBs Ag(+)group has a unique clinical features: Compared with Hbs Ag(-)group,the patients in the Hbs Ag(+)group had higher disease stage(III or IV),higher IPI score and susceptible to spleen,which indicated that HBV infection might promote DLBCL disease progression.3.Univariate survival analysis showed that HBV infection,IPI(high risk group),CMYC positive,BCL-2 positive and BCL-2 / CMYC co-expression were all poor prognostic factors of OS and PFS in DLBCL patients;Cox Multivariate survival analysis showed that BCL-2 / CMYC double expression and IPI high risk group were independent prognostic factors of OS and PFS in DLBCL patients.The expression of BCL-2 protein in DLBCL patients was significantly higher than that in Hbs Ag(-)group,HBV infection may affect the development and prognosis of DLBCL by regulating the role of BCL-2. |
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