59例弥漫大B细胞淋巴瘤临床特征及预后分析

发布时间：2018-03-01 09:46

  本文关键词： 弥漫大B细胞淋巴瘤 国际预后指数 免疫亚型 分子标志物 预后　出处：《青海大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:弥漫大B细胞淋巴瘤(diffuse large B-cell lymphom,DLBCL)是非霍奇金淋巴瘤中最为常见的一类具有明显异质性的恶性肿瘤。本文探讨59例初诊DLBCL患者的一般临床资料及免疫组织化学资料特点,并分析其预后意义,进一步从分子水平上认识DLBCL。方法:收集2010年08月至2015年12月在青海大学附属医院经病理及免疫组织化学检查确诊的59例DLBCL患者的病例资料,即一般临床资料(性别、年龄、临床分期、ECOG评分、原发部位、IPI、外周血ALC、血清LDH)、免疫组织化学资料(免疫亚型、Bcl-2、Ki-67、CD5)及治疗方法、总生存期,探讨DLBCL患者发病的一般情况、分子标志物等指标特点及各指标在预后中的意义。应用SPSS21.0进行统计学分析,P0.05为差异有统计学意义。结果:1.一般情况:59例初诊DLBCL患者中,男女比例为1.36:1,平均发病年龄为56.80±13.70(16~87)岁,外周血ALC和血清LDH水平在I+II期、III+IV期组两组中比较差异有统计学意义(P=0.030、0.045)。2.原发部位:59例初诊的DLBCL患者,其中33(55.93%)例为原发淋巴结内的患者;26(44.07%)例为原发淋巴结外的患者,结外部位中以原发胃部最多为8(32.00%)例,仅1例患者原发于中枢神经系统,其发病特点为临床分期较晚、ECOG评分3分、结外累及病变数≥2个、non-GCB型、Ki-67为80%。生存分析显示,原发胃DLBCL患者的3年OS率与其他结外患者比较,差异无统计学意义(71.4%vs 72.5%,P=0.465)。3.免疫组织化学检查:免疫亚型在全组53例DLBCL患者中的分布情况为non-GCB型较多见,与在结内、结外、胃部及非胃部中的分布情况一致。Ki-67平均表达水平为63.13%±16.90%(20%~90%),高表达(Ki-67≥50%)患者占80.36%;Bcl-2阳性表达的患者高达80.65%;部分患者(33.33%)CD5阳性表达。GCB型患者的3年OS率高于non-GCB型患者(87.5%vs 47.7%,P=0.043);Bcl-2、CD5阳性表达患者的3年OS率与阴性表达患者比较,差异无统计学意义(65.3%vs 50.0%,P=0.474;66.7%vs 100.0%,P=0.248),3年OS率在Ki-67高、低表达患者中亦无明显差异(62.5%vs 67.1%,P=0.635)。4.生存分析:年龄、临床分期、ECOG评分、IPI、免疫亚型、有无应用R治疗与DLBCL的预后密切相关(P值分别为0.020、0.017、0.032、0.009、0.043、0.013)。Bcl-2、Ki-67、CD5对DLBCL患者的3年OS率无明显影响(P0.05)。IPI、免疫亚型及有无应用R治疗为DLBCL的独立预后因素(P值分别为0.017、0.009、0.030)。结论:1.外周血ALC、血清LDH在不同临床分期患者中的变化可作为监测DLBCL病情动态变化的重要指标。2.DLBCL中,原发淋巴结内患者较结外多见,结外以原发胃肠道最多。3.DLBCL发病时,non-GCB型患者较常见,Bcl-2阳性、Ki-67高表达患者多见,部分患者CD5阳性表达。4.免疫亚型、年龄、临床分期、IPI、ECOG评分、有无应用R治疗是DLBCL的预后因素,影响患者的3年OS率;Bcl-2、Ki-67、CD5蛋白表达对患者的3年OS率无明显影响。免疫亚型、IPI、有无应用R治疗是影响DLBCL患者3年OS率的独立预后因素。
[Abstract]:Objective: diffuse large B-cell lymphoma (DLBCLs) is the most common type of malignant tumor with obvious heterogeneity in non-Hodgkin 's lymphoma. The clinical and immunohistochemical characteristics of 59 newly diagnosed DLBCL patients were studied. The prognostic significance of DLBCL.Methods: from August 2010 to December 2015, 59 cases of DLBCL confirmed by pathological and immunohistochemical examination in affiliated Hospital of Qinghai University were collected. That is, general clinical data (sex, age, clinical stage and ECOG score, primary site of IPI, peripheral blood ALC, serum LDHH, immunohistochemical data (immune subtype Bcl-2Ki-67-CD5), treatment method, total survival period, to explore the general situation of DLBCL patients. The significance of molecular markers and other indexes in prognosis was statistically significant using SPSS21.0. Results: 1. In the general situation of 59 newly diagnosed DLBCL patients, the ratio of male to female was 1.36: 1, and the average age of onset was 56.80 卤13.701687.The results showed that the average age of onset was 56.80 卤13.701687.Results in the general situation, the ratio of male to female was 1.36: 1 in 59 newly diagnosed DLBCL patients. The levels of ALC in peripheral blood and LDH in serum were significantly different between the two groups in III stage III IV group. There was a significant difference between the two groups. Among the 59 newly diagnosed DLBCL patients, 3355.93 were primary lymph node patients and 2644.07 were primary lymph nodes. In the external nodal position, the primary stomach was 832. 00) and only 1 patient was primary in the central nervous system. The disease was characterized by late clinical stage and ECOG score 3, and the number of extranodular involvement 鈮，

本文编号：1551405