C-myc蛋白及基因在间变大细胞淋巴瘤中的表达及意义

发布时间：2018-01-08 16:36

本文关键词：C-myc蛋白及基因在间变大细胞淋巴瘤中的表达及意义　出处：《山西医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:探讨c-myc在系统性间变性大细胞淋巴瘤(ALCL)中的蛋白表达和基因异常与临床病理特征、免疫组织分型及预后的关系。方法:病例选自山西省肿瘤医院2006~2011年有临床病理资料和随访资料的ALCL石蜡样本87例,21例淋巴结反应性增生标本作为对照。(1)应用免疫组织化学En Vision法检测ALK、c-myc、CD3、CD10、CD20、CD30、EMA、Ki-67的蛋白表达情况并进行免疫分型;(2)应用荧光原位杂交(FISH)技术检测c-myc和ALK基因异常情况;(3)统计分析c-myc蛋白表达和基因异常与各临床病理参数及预后的关系。结果:(1)免疫组化结果:c-myc和ALK在ALCL组织中的阳性表达率分别为31%和62.1%,与对照组比较差异具有统计学意义(P0.05);c-myc和ALK蛋白联合表达20例(23%);c-myc蛋白表达率在ALK阳性与ALK阴性组中差异无统计学意义(P0.05)。(2)c-myc蛋白表达率、c-myc和ALK蛋白联合表达率在ALCL的各临床分期和不同国际预后指数(IPI)间的差异有统计学意义(P0.05),而与患者的性别、年龄、有无B症状、淋巴结外累及数目及骨髓浸润差异均无统计学意义(P0.05)。(3)FISH检测结果:在ALCL中,大部分出现ALK基因的异常(64.4%),以ALK基因的易位最为多见(57.5%);ALCL中不见或罕见c-myc基因易位,但可见c-myc基因多拷贝(21.8%)。(4)c-myc基因多拷贝的发生率在ALK蛋白阳性和ALK阴性组中的差异无统计学意义(P0.05);在c-myc蛋白阳性和阴性组中的差异有统计学意义(P0.05);在ALCL不同国际预后指数(IPI)间的差异有统计学意义(P0.05)。(5)Kaplan-Meier单因素分析结果:c-myc蛋白阳性表达和c-myc基因多拷贝的ALCL患者,其PFS和OS均短于阴性表达的患者,差异有统计学意义(P0.05)。(6)多因素Cox Regression模型参数预后分析:IPI评分、ALK蛋白表达及c-myc基因多拷贝是影响ALCL患者生存的危险因素(P0.05)。结论:(1)c-myc在间变大细胞淋巴瘤中的表达高于对照组,提示c-myc表达参与了间变大细胞淋巴瘤的发生、发展。(2)c-myc蛋白表达及基因异常、ALK和c-myc蛋白联合表达与ALCL的临床分期和IPI评分有关,可作为判断ALCL恶性程度的指标。(3)IPI评分、ALK蛋白表达及c-myc基因多拷贝是影响ALCL患者生存的危险因素,可作为判断ALCL预后的独立指标。
[Abstract]:Objective: To investigate the effects of c-myc on systemic anaplastic large cell lymphoma (ALCL) protein expression and gene abnormalities and clinical pathological features, relationship between immune tissue typing and prognosis. Methods: a case from the tumor hospital of Shanxi province 2006~2011 sample ALCL paraffin clinical pathological data and follow-up data of 87 cases, 21 cases of lymph node reaction hyperplasia were used as control. (1) immunohistochemistry En Vision method to detect ALK, c-myc, CD3, CD10, CD20, CD30, EMA, Ki-67 protein expression and immunophenotype; (2) using fluorescence in situ hybridization (FISH) detection of c-myc and ALK gene abnormality (3); statistical analysis of the relationship between c-myc protein expression and gene abnormality and the clinicopathological parameters and prognosis. Results: (1) the results of immunohistochemistry: the positive expression of c-myc and ALK in ALCL tissues was respectively 31% and 62.1%, the difference was statistically significant compared with the control group (P 0.05); c-myc and ALK protein expression in 20 cases (23%); there was no significant difference in the ALK positive and ALK negative group in c-myc protein expression (P0.05). (2) the expression rate of c-myc, c-myc and ALK protein expression rate in the clinical ALCL staging and different international prognostic index (IPI) was statistically significant difference (P0.05), and the age and sex of the patient, and the presence of B symptoms, extranodal involvement and the number of bone marrow infiltration showed no significant difference (P0.05). (3) the results of FISH: in ALCL, most of the abnormal ALK gene (64.4%), ALK gene translocation was most common (57.5%); or rare c-myc gene translocation not seen in ALCL, but the multiple copies of c-myc gene (21.8%). (4) multiple copies of the c-myc gene in differences in incidence of ALK positive and ALK negative group had no statistical significance (P0.05); there were significant differences in c-myc positive and negative group in the The significance (P0.05); ALCL in different international prognostic index (IPI) was statistically significant difference (P0.05). (5) Kaplan-Meier single factor analysis results: the positive expression of c-myc protein and multiple copies of the c-myc gene in patients with ALCL, PFS and OS were shorter than negative patients, the difference was statistically significant (P0.05). (6) multi factor analysis of Cox Regression model parameters prognosis: IPI score, ALK protein expression and c-myc gene copy is the influence of risk factors of survival of patients with ALCL (P0.05). Conclusion: (1) the c-myc expression of large cell lymphoma in higher than in the control group, suggesting that the expression of c-myc in between large cell lymphoma, development. (2) the expression of c-myc protein and gene abnormality, co expression of ALK and c-myc protein and the clinical stage of ALCL and IPI score, can be used to judge the malignant degree of ALCL index (3). The scores of IPI, ALK protein expression and c-myc gene copy. The risk factors for the survival of the patients with ALCL can be used as an independent indicator of the prognosis of ALCL.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R733.1

【相似文献】