Li Min, Liu Cui-ling, Wang Xiao-yan, Xue Xue-min, Gao Zi-fen
Department of Pathology, Peking University Health Sciences Center, Beijing 100191, China.
Zhonghua Bing Li Xue Za Zhi. 2012 Dec;41(12):813-7. doi: 10.3760/cma.j.issn.0529-5807.2012.12.005.
To investigate the clinical significance of bcl-2 protein expression and three classification algorithms including Hans model, Chan model and Muris model in patients with diffuse large B-cell lymphoma (DLBCL).
Two-hundred and thirty-seven cases were collected. Standard two-step EnVision method of immunohistochemical staining was used to assess the expression of Ki-67, CD3, CD45RO, CD20, CD79a, bcl-2, bcl-6, CD10, MUM-1, GCET-1, and FOXP-1. The phenotypic classifications were assessed according to the standard of the three models.
The male (131 cases) to female (106 cases) ratio was about 1.24:1, the average age was 52.6 years. Seventy-five cases (31.6%, 75/237) showed primarily lymph node involvement. Gastrointestinal tract (71 cases) was the most commonly involved extra-nodal organ. All cases expressed one or more pan B cell markers such as CD20 (99.1%, 231/233). All patients with complete clinical follow-up data survived from 1 - 120 months. The expression of bcl-2 protein indicated an adverse prognosis (P = 0.019). Two-hundred and thirty cases were classified according to Hans model, with ninety five GCB cases and one-hundred and thirty five non-GCB cases. Survival analysis showed no difference between GCB and non-GCB subtypes (P = 0.102). According to the Chan's algorithm, sixty eight case of one-hundred and eighty one were belong to GCB group, with one-hundred and thirteen non-GCB cases. GCB subtype showed much better prognosis than non-GCB subtype according to survival analysis (P = 0.031). Additionally, bcl-2 protein expression in non-GCB subtype showed the worst survival. In Muris' model, 154 of 218 cases were classified as Group 1, while 64 cases were classified as Group 2. Group 1 showed better prognosis than Group 2 (P < 0.05).
Non-GCB group is the more common type of DLBCL in China. High expression of bcl-2 protein is detected in the non-GCB group. Not all subgroups classified with different classification models indicate different prognosis. Bcl-2 expression combined with Chan's algorithm may be the best tool to predict outcome.
探讨bcl-2蛋白表达以及包括汉斯模型、陈模型和穆里斯模型在内的三种分类算法在弥漫性大B细胞淋巴瘤（DLBCL）患者中的临床意义。
收集237例病例。采用标准的两步EnVision免疫组织化学染色方法评估Ki-67、CD3、CD45RO、CD20、CD79a、bcl-2、bcl-6、CD10、MUM-1、GCET-1和FOXP-1的表达。根据三种模型的标准进行表型分类评估。
男性（131例）与女性（106例）比例约为1.24:1，平均年龄为52.6岁。75例（31.6%，75/237）主要表现为淋巴结受累。胃肠道（71例）是最常受累的结外器官。所有病例均表达一种或多种泛B细胞标志物，如CD20（99.1%，231/233）。所有具有完整临床随访数据的患者生存1至120个月。bcl-2蛋白表达提示预后不良（P = 0.019）。根据汉斯模型对230例进行分类，其中95例为生发中心B细胞（GCB）型，135例为非GCB型。生存分析显示GCB型和非GCB型亚型之间无差异（P = 0.102）。根据陈算法，181例中有68例属于GCB组，113例为非GCB组。生存分析显示GCB亚型的预后明显优于非GCB亚型（P = 0.031）。此外，非GCB亚型中bcl-2蛋白表达的患者生存最差。在穆里斯模型中，218例中有154例被分类为第1组，64例被分类为第2组。第1组的预后优于第2组（P < 0.05）。
非GCB组是中国DLBCL中较常见的类型。在非GCB组中检测到bcl-2蛋白高表达。并非所有用不同分类模型分类的亚组都提示不同的预后。bcl-2表达结合陈算法可能是预测预后的最佳工具。
