| Background:Diffuse large B cell lymphoma(DLBCL)is the most common invasive form of adult Non-Hodgkin's lymphoma,with heterogeneity in clinical manifestations,morphology,and biological behavior,and recurrence/refractory in 30%to 40%of patients treated with RCHOP standard regimen.World Health Organization recommended cell of origin classification and fluorescence in situ hybridization need to be test for DLBCL patients.The National Comprehensive Cancer Network guidelines indicated that patients with double-hit/triple-hit lymphoma had a poor prognosis and that double expression of MYC/BCL2 was also a poor prognostic factor for DLBCL.Most studies had found that DLBCL patients with primary CD5 positive had a poor prognosis,so it is necessary to fully investigate biomarkers related with DLBCL for risk stratification,prognosis analysis and treatment guidance of patients.Objective:To investigate the interaction and prognosis of CD5,BCL2 and MYC protein overexpression in DLBCL patients.Methods:1.Clinical data were collected from 396 patients newly diagnosed with DLBCL in thethird affiliated hospital of Xinxiang Medical College and the first affiliated hospital of Zhengzhou University on May 1,2013 and July 1,2019.All patients underwent immunohistochemical detection of CD5,MYC,BCL2,BCL6,CD10 and MUM1proteins.Among them,308 patients were treated with RCHOP or RCHOP like regimen,while 88 patients were treated with CHOP or CHOP like regimen.The efficacy criteria of LUGANO lymphoma recommended by NCCN were evaluated and the patients were followed up to observe progression-free survival and overall survival of the patients.2.Statistical analysis:SPSS 22.0 software was used for statistical analysis of the samples,and the non-normal distribution measurement data were expressed as median.The frequency data were compared by X~2 test.Survival rate was compared by log-rank test.Kaplan-Meier method was used for the survival curve.COX regression model was used for multivariate analysis.P<0.05 was considered statistically significant.Results:1.There were 216 males and 180 females with a median age of 56(10-86)years in 396cases of DLBCL.According to Ann Arbor staging,187 patients(47.2%)had stage I/II and209 patients(52.8%)had stage III or IV.IPI scores ranged from 0 to 2 in 265 patients(66.9%)and 3 to 5 in 131 patients(33.1%).There were 119 cases(30.1%)with germinal center type,277 cases(69.9%)with non-germinal center type,187 cases(47.2%)with MYC positive,278 cases(70.2%)with BCL2 positive and 155 cases(39.1%)with double expression of MYC/BCL2.2.Compared with 345 cases(87.1%)with CD5 negative,51 patients(12.9%)with CD5positive were more likely to involve bone marrow,invasion of multiple extranodal sites,BCL2 positive and elevated LDH.3.The 3-year PFS of DLBCL patients with BCL2+,CD5+,MYC+/BCL2+,CD5+/BCL2+,CD5+/MYC+and CD5+/MYC+/BCL2+were 41.6%,40.2%,35.8%,35.3%,25.1%and 23.9%respectively.The 3-year OS of DLBCL patients with BCL2+,CD5+,MYC+/BCL2+,CD5+/BCL2+,CD5+/MYC+andCD5+/MYC+/BCL2+were 52.5%,56.4%,47.6%,44.4%,30.5%and 28.9%respectively.Both PFS and OS of DLBCL patients with BCL2+,CD5+,MYC+/BCL2+,CD5+/BCL2+,CD5+/MYC+and CD5+/MYC+/BCL2+were significantly shortened.4.The results of univariate analysis showed that elevated LDH,extranodal sites?2,stage(III or IV),IPI(3-5 points),CHOP/CHOP like treatment regimen,BCL2 positive,CD5 positive and double expression of MYC/BCL2 were the poor prognostic factors.Multivariate analysis showed that age>60 years old,extranodal sites?2,CHOP/CHOP like treatment regimen and BCL2 positive were independent prognostic factors.Conclusions:1.BCL2+,CD5+and MYC+/BCL2+were all poor prognostic factors for patients with diffuse large B cell lymphoma.2.CD5 overexpression enhanced the adverse prognosis of patients with BCL2+,MYC+and MYC+/BCL2+in diffuse large B cell lymphoma. |
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