血管免疫母细胞性T细胞淋巴瘤临床-病理-分子遗传学改变与预后相关性分析

发布时间：2018-03-03 09:08

  本文选题：淋巴瘤　切入点：免疫组织化学　出处：《中华肿瘤防治杂志》2017年06期 　论文类型：期刊论文

【摘要】：目的血管免疫母细胞性T细胞淋巴瘤(angioimmunoblatic T-cell lymphoma,AITL)是一种侵袭性淋巴瘤,本研究探讨AITL的临床病理特征、与EB病毒相关性及分子遗传学改变,并分析相关预后因素。方法选取2003-01-03-2012-12-31新疆医科大学第一附属医院有详细临床病理资料的16例AITL患者石蜡样本,EnVision法进行CXCL13、PD-1、CD10和Bcl-6免疫标记;原位杂交技术检测肿瘤EB病毒编码mRNA表达情况;荧光原位杂交技术检测肿瘤组织中Bcl-2、Bcl-6和C-MYC基因异常情况,并对所有患者进行随访。结果 16例患者,男11例(68.8%),女5例(31.2%),男女比例2.2∶1。中位年龄65.5岁。75.0%(12/16)患者国际预后指标(international prognostic indicators,IPI)评分为中高危,56.3%(9/16)患者血清乳酸脱氢酶(lactic dehydrogenase,LDH)异常,20%(2/10)患者存在骨髓侵犯,81.3%(13/16)患者临床分期为ⅢB期及以上;免疫组织化学染色结果示,CXCL13、PD-1、CD10、Bcl-6阳性率分别为93.8%(15/16,95%CI为70%~100%)、75.0%(12/16,95%CI为48%~93%)、50.0%(8/16,95%CI为25%~75%)和81.3%(13/16,95%CI为54%~96%);AITL显示特征性的CD23和CD21滤泡树突状细胞网增生,阳性率均为87.5%(14/16,95%CI为62%~98%);原位杂交:EBER阳性率为56.3%(9/16,95%CI为30%~80%);FISH检测结果示,10例AITL患者Bcl-2/IgH、Bcl-6、C-myc检测均为阴性;术后电话随访,自病理确诊之日起开始计算生存期,15例患者有随访结果。随访1~84个月,全组中位生存期为17个月;其中5例在1年内死亡,1年生存率为66.7%(5/15),总共6例患者死亡,占全组的40.0%(6/15)。单因素分析显示,年龄≥65岁、IPI评分高危组、LDH水平异常、临床病理分期ⅢB~Ⅳ期患者预后较差。结论 AITL好发于老年患者,具有高度侵袭性,预后差,CXCL13、PD-1、CD10、Bcl-6可作为一个免疫组化套餐,在该肿瘤的诊断具有重要作用,临床病理分期、IPI评分、LDH水平是影响预后的重要因素。
[Abstract]:Objective angioimmunoblastic T-cell lymphoma (AITL) is an aggressive lymphoma. This study was designed to investigate the clinicopathological features of AITL, its association with Epstein-Barr virus (EBV) and the molecular genetic changes. Methods 16 AITL patients with detailed clinicopathological data were selected from the first affiliated Hospital of Xinjiang Medical University from January 2003 to March 2003.The paraffin envision method was used for CXCL13PD-1 CD10 and Bcl-6 immunolabeling. In situ hybridization technique was used to detect the expression of EBV encoded mRNA, and fluorescence in situ hybridization was used to detect the abnormality of Bcl-2, Bcl-6 and C-MYC genes in tumor tissues, and all the patients were followed up. The international prognostic indicatorsIPI (a median age of 65.5 years .75.0% / 12 / 16) score of international prognostic indicatorsIPI (a median age of 65.5 years .75.0% / 12 / 16) showed that the patients with moderate and high risk (56.3% / 9 / 16) had abnormal serum lactate dehydrogenase dehydrogenase (LDH) abnormality (201.31313 / 16) and the patients had bone marrow invasion (81.31313 / 16). The results of immunohistochemical staining showed that the positive rate of CXCL13PD-1 CD10Bcl-6 was 93.8151516995 CI = 7055.00 / 75.00 / 75.00 / 12 / 169595 / CI, respectively, and the CI was 480.9339.05% and the CI of 81.33% (1316995 CI = 257575) and 81.33% 131616995 CI (51.33%) and 51.33% 131616995 CI (54.93%) and 54.3% 1316995 CI (54.93% / 9695 CI), respectively. The CXCL13PD-1CD10Bcl-6 positive rate was 93.81516995 CI = 705,16995 CI = 705.00% and 75.05%, respectively. The positive rate of in situ hybridization was 56.3% and the positive rate of in situ hybridization was 56.3%. The positive rate of in situ hybridization was 56.3% and the CI was 30%. The results of fish showed that all 10 cases of AITL were negative for Bcl-2% IgHV Bcl-6C-myc, and 15 patients with survival period were followed up from the day of postoperative telephone follow-up. The median survival time of the whole group was 17 months, of which 5 cases died within one year, and the 1-year survival rate was 66.7%. A total of 6 cases died, accounting for 40.0% of the total. Univariate analysis showed that the high risk group of age 鈮，

本文编号：1560393