BCL-2、MYC基因异常对弥漫大B细胞淋巴瘤患者预后的影响

OBJECTIVE: To investigate the effect of BCL-2/MYC double-hit on prognosis in diffuse large B-cell lymphoma (DLBCL). METHODS: A retrospective study was conducted to investigate clinical and pathological data of 111 patients with DLBCL. CD10, BCL-6, MUM-1, BCL-2 protein expressions were examined by immune-histochemical methods, and abnormal BCL-2 and MYC genes were analyzed by FISH for patients with sufficient pathological data. SAS 8.2 was adopted to perform Chi-square test, COX's proportional Hazard Model, Life table survival analyses. RESULTS: Of 111 patients, male 77 cases, female 34 cases, the median age was 55 (14-85)years, CD10, BCL-6, MUM-1, BCL-2 positive rates were 15.7% (16/102), 58.8% (60/102), 33.0% (34/103), 74.8 (77/103)respectively, the abnormal rate of BCL-2 gene was 43.1% (25/58, 24 cases with multiple copies, 1 case with translocation), and the abnormal rate of MYC gene was 20.4% (10/49, 10 cases with multiple copies). Coexistence of BCL-2 and MYC genes abnormalities accounted for 13.0% (6/46). According to the classification of Hans model, GCB subgroup accounted for 41.2% (42/102), and non-GCB subgroup 58.8% (60/102), the median survival time was 24 months, 3-year and 5-year overall survival rates were 48.5% and 39.7% respectively. Overall survival rates of normal and abnormal BCL-2 gene were 34.2%,22.8%, respectively with no statistical significance (P=0.770). Overall survival rates of normal and abnormal MYC gene were 35.9% and 22.2%, with no statistical significance (P=0.650). Overall survival rate of double-hit was 0, far worse than that of single abnormal gene (P=0.034), which implied double-hit of BCL-2 and MYC gene abnormality to be adverse prognostic factors. BCL-6 protein express could be classified as benign prognostic factors, while ECOG score≥2, escalated IPI index as adverse prognostic factors, and further COX risk model regression analysis indicated that ECOG score, IPI grading and treatment methods were independently adverse factors affecting prognosis. Comprehensive therapy based on chemotherapy could improve outcome. CONCLUSION: BCL-2/MYC genes double-hit was the factor for the adverse outcome in DLBCL patients. However, ECOG score, IPI risk grading and treatment methods were the independent factors affecting prognosis.