Chang Chung-Che, Kampalath Bal, Schultz Christopher, Bunyi-Teopengco Ellen, Logan Brent, Eshoa Camellia, Dincer Ayse P, Perkins Sherrie L
Department of Pathology, Medical College of Wisconsin, Milwaukee 53226, USA.
Arch Pathol Lab Med. 2003 Feb;127(2):208-12. doi: 10.5858/2003-127-208-EOPMOB.
Primary central nervous system (CNS) diffuse large B-cell lymphoma (DLBCL) in immunocompetent individuals, although rare, has been rising in incidence. Currently, no reliable prognostic markers are available for these individuals.
To study the implications of expression of a panel of oncogenic proteins (Bcl-2, Bcl-6, and c-Myc) and p53 for predicting clinical outcome, particularly overall survival, in immunocompetent individuals with primary CNS DLBCL.
Fourteen primary CNS DLBCL cases were retrospectively studied by immunohistochemistry on formalin-fixed, paraffin-embedded sections for the expression of c-Myc, Bcl-2, Bcl-6, and p53.
The overall frequencies of expression for p53, c-Myc, Bcl-2, and Bcl-6 in these cases were 29%, 50%, 71%, and 57%, respectively. Cases with expression of p53, c-Myc, or Bcl-6 had a poorer overall survival than those without (Kaplan-Meier survival analysis: 50% cumulative overall survival, 2 months vs 30-60 months, P =.02, log-rank test; 9-16 months vs 21-60 months, P =.03, log-rank test; and 9-16 months vs 21-60 months, P =.16, log-rank test, respectively). The expression of Bcl-2 or proliferation activity by MIB-1 showed no correlation with overall survival. Likewise, the clinical parameters, including age, location of tumors, multiplicity of tumor lesions, and lactase dehydrogenase levels revealed no impact on overall survival.
Our results suggest that patients with expression of p53, c-Myc, or Bcl-6 have a poorer overall survival than those without. Since traditional prognostic markers in non-CNS DLBCL, such as staging and International Prognostic Index scores, are not applicable to primary CNS DLBCL, evaluation of p53, c-Myc, and Bcl-6 by immunohistochemistry may be warranted as part of prognostic evaluation in immunocompetent patients with primary CNS DLBCL. Further studies are indicated to confirm our observations.
在免疫功能正常的个体中，原发性中枢神经系统（CNS）弥漫性大B细胞淋巴瘤（DLBCL）虽然罕见，但发病率一直在上升。目前，这些个体尚无可靠的预后标志物。
研究一组致癌蛋白（Bcl-2、Bcl-6和c-Myc）和p53的表达对免疫功能正常的原发性中枢神经系统DLBCL个体临床结局，尤其是总生存期的预测意义。
通过免疫组织化学方法，对14例原发性中枢神经系统DLBCL病例的福尔马林固定、石蜡包埋切片进行回顾性研究，检测c-Myc、Bcl-2、Bcl-6和p53的表达情况。
这些病例中p53、c-Myc、Bcl-2和Bcl-6的总体表达频率分别为29%、50%、71%和57%。p53、c-Myc或Bcl-6表达阳性的病例总生存期较无表达者差（Kaplan-Meier生存分析：累积总生存率50%，分别为2个月与30 - 60个月，P = 0.02，对数秩检验；9 - 16个月与21 - 60个月，P = 0.03，对数秩检验；9 - 16个月与21 - 60个月，P = 0.16，对数秩检验）。Bcl-2的表达或MIB-1检测的增殖活性与总生存期无相关性。同样，临床参数，包括年龄、肿瘤位置、肿瘤病变的多发性和乳酸脱氢酶水平，对总生存期均无影响。
我们的结果表明，p53、c-Myc或Bcl-6表达阳性的患者总生存期较无表达者差。由于非中枢神经系统DLBCL的传统预后标志物，如分期和国际预后指数评分，不适用于原发性中枢神经系统DLBCL，因此通过免疫组织化学评估p53、c-Myc和Bcl-6可能作为免疫功能正常的原发性中枢神经系统DLBCL患者预后评估的一部分。需要进一步研究以证实我们的观察结果。
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