163例弥漫大B细胞淋巴瘤患者预后相关免疫表型研究

OBJECTIVE: To screen and analyze the prognostic protein biomarkers of DLBCL, and to explore their value in the prognostic evaluation. METHODS: 163 cases of confirmed DLBCLs from January 2011 to December 2016 were collected with their clinical, pathological and follow-up data, which were all from our hospital. The expression of protein markers were tested using immunohistochemical staining（IHC）. The immune phenotypes independent of the International Prognostic Index（IPI）that affect overall survival（OS）and progression-free survival（PFS）of DLBCL were explored by COX regression model, and the effect of their co-expression on the prognosis were also analyzed. RESULTS: BCL6 negative（PFS: HR＝1.652, 95％ CI 1.030–2.649, P＝0.037）, P53 positive（OS: HR＝1.842, 95％ CI 1.008–3.367, P＝0.047）, and BCL2 strong positive expressions（S +）（OS: HR＝2.102, 95％ CI 1.249–3.537, P＝0.005; PFS: HR＝2.126, 95％ CI 1.312–3.443, P＝0.002）are adverse prognostic factors of DLBCL that are independent of IPI. BCL6(−)（PFS: HR＝2.042, 95％ CI 1.021–4.081, P＝0.043）, P53 (+)（OS: HR＝3.069, 95％CI 1.244–7.569, P＝0.015）and BCL2(S+)（OS: HR＝2.433, 95％CI 1.165–5.082, P＝0.018; PFS: HR＝3.209, 95％CI 1.606–6.410, P＝0.001）are adverse prognostic factors in the group of age≤60-year-old; in the group of IPI score 0–2, cases with BCL6(−)（OS: HR＝2.467, 95％CI 1.322–4.604, P＝0.005; PFS: HR＝2.248, 95％CI 1.275–3.965, P＝0.005）and BCL2(S +)（PFS: HR＝2.045, 95％CI 1.119–3.735, P＝0.020）have worse prognosis. The co-expression of BCL6(−) and BCL2(S +) has significant influence on prognosis of DLBCL（P＝0.005 and P<0.001）, in which BCL6(+)/non-BCL2(S+)（n＝86）has the best prognosis［3-year-OS（71.6±4.9）％, 3-year-PFS（67.0±5.1）％］, and BCL6(−)/BCL2(S+)（n＝10）has the worst prognosis［3-year-OS（20.0±12.6）％, 3-year-PFS（10.0±9.5）％］; the co-expression of BCL6(−) and P53(+) has no significant influence on prognosis（P＝0.061 and P＝0.089）, however, those cases with BCL6(+)/P53(−)（n＝98）often get better prognosis［3-year-OS（70.6±4.7）％, 3-year-PFS（64.6±4.9）％］than others; the co-expression of P53(+) and BCL2(S +) has significant influence on prognosis of DLBCL（P<0.001 and P<0.001）, and P53(+)/BCL2(S+)（n＝5）has the worst prognosis（3-year-OS and 3-year-PFS are both 0）; BCL2(S+) cases get shorter OS and PFS, regardless of the expression of BCL6 and P53. CONCLUSION: The expression and coexpression of BCL6 negative, P53 positive and BCL2(S +) have certain value in the prognostic evaluation of DLBCL, especially in the group of age≤60-year-old and IPI score 0–2.