Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, 104-0045 Tokyo, Japan.
Hum Pathol. 2013 Nov;44(11):2529-35. doi: 10.1016/j.humpath.2013.06.013. Epub 2013 Jul 31.
This study aimed to determine the correlations of 7 histopathologic prognostic indicators of follicular lymphoma (follicular lymphoma grade, CD10 expression, Bcl-2 expression, IGH/BCL2 fusion, diffuse area, fibrosis, and marginal zone differentiation) with progression-free survival, overall survival, and follicular lymphoma histologic grade in 255 follicular lymphoma patients who were treated with rituximab-containing therapy. The complete response, overall response, 6-year progression-free survival, and 6-year overall survival rates were 83%, 96%, 56%, and 97%, respectively. Patients with follicular lymphoma grades 3a and 3b showed 100% 6-year and 10-year overall survival, and progression-free survival did not significantly differ between patients with follicular lymphoma grade 3 and those with follicular lymphoma grades 1 and 2. The absence or presence of Bcl-2 expression and intensity of Bcl-2 expression were not significant prognostic indicators of progression-free survival and overall survival. Likewise, the presence of IGH/BCL2 fusion, diffuse area, fibrosis, and marginal zone differentiation were not significantly correlated with progression-free survival and overall survival. Follicular lymphoma grade 3 was correlated with nodal disease and negative or lower intensity of Bcl-2 expression, but not with age, stage, or IGH/BCL2 status. In the prerituximab era, grade 3 disease was reported to be associated with a poor prognosis; however, the opposite was true for patients treated with rituximab-containing therapy, regardless of their age or disease stage. Bcl-2 expression and marginal zone differentiation were not prognostic indicators in follicular lymphoma patients treated with rituximab-containing therapy.
本研究旨在确定滤泡性淋巴瘤（滤泡性淋巴瘤分级、CD10 表达、Bcl-2 表达、IGH/BCL2 融合、弥漫区、纤维化和边缘区分化）7 种组织病理学预后指标与无进展生存、总生存和滤泡性淋巴瘤组织学分级在 255 例接受含利妥昔单抗治疗的滤泡性淋巴瘤患者中的相关性。完全缓解率、总缓解率、6 年无进展生存率和 6 年总生存率分别为 83%、96%、56%和 97%。滤泡性淋巴瘤 3a 和 3b 级患者的 6 年和 10 年总生存率均为 100%，滤泡性淋巴瘤 3 级患者与滤泡性淋巴瘤 1 级和 2 级患者的无进展生存率无显著差异。Bcl-2 表达的缺失或存在以及 Bcl-2 表达的强度均不是无进展生存和总生存的显著预后指标。同样，IGH/BCL2 融合、弥漫区、纤维化和边缘区分化与无进展生存和总生存也无显著相关性。滤泡性淋巴瘤 3 级与结内疾病和 Bcl-2 表达阴性或低强度相关，但与年龄、分期或 IGH/BCL2 状态无关。在利妥昔单抗治疗前时代，3 级疾病被报道与预后不良相关；然而，在接受含利妥昔单抗治疗的患者中，情况恰恰相反，与患者的年龄或疾病分期无关。Bcl-2 表达和边缘区分化不是接受含利妥昔单抗治疗的滤泡性淋巴瘤患者的预后指标。
