Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China.
PLoS One. 2014 Apr 16;9(4):e95020. doi: 10.1371/journal.pone.0095020. eCollection 2014.
Various studies have investigated the prognostic value of C-MYC aberrations in diffuse large B-cell lymphoma (DLBCL). However, the role of C-MYC as an independent prognostic factor in clinical practice remains controversial. A systematic review and meta-analysis were performed to clarify the clinical significance of C-MYC aberrations in DLBCL patients.
The pooled hazard ratios (HRs) for overall survival (OS) and event-free survival (EFS) were calculated as the main effect size estimates. The procedure was conducted according to the Cochrane handbook and PRISMA guidelines, including the use of a heterogeneity test, publication bias assessment, and meta-regression, as well as subgroup analyses.
Twenty-four eligible studies enrolling 4662 patients were included in this meta-analysis. According to the nature of C-MYC aberrations (gene, protein, and mRNA), studies were divided into several subgroups. For DLBCL patients with C-MYC gene abnormalities, the combined HR was 2.22 (95% confidence interval, 1.89 to 2.61) for OS and 2.29 (95% confidence interval, 1.81 to 2.90) for EFS, compared to patients without C-MYC gene abnormalities. For DLBCL patients with overexpression of C-MYC protein and C-MYC mRNA, pooled HRs for OS were 2.13 and 1.62, respectively. C-MYC aberrations appeared to play an independent role among other well-known prognostic factors in DLBCL. Addition of rituximab could not overcome the inferior prognosis conferred by C-MYC.
The present systematic review and meta-analysis confirm the prognostic value of C-MYC aberrations. Screening of C-MYC should have definite prognostic meaning for DLBCL stratification, thus guaranteeing a more tailored therapy.
多项研究调查了 C-MYC 异常在弥漫性大 B 细胞淋巴瘤（DLBCL）中的预后价值。然而，C-MYC 是否为独立的临床预后因素仍存在争议。本系统评价和荟萃分析旨在阐明 C-MYC 异常在 DLBCL 患者中的临床意义。
汇总总生存（OS）和无事件生存（EFS）的风险比（HR）作为主要效应量估计。该过程根据 Cochrane 手册和 PRISMA 指南进行，包括使用异质性检验、发表偏倚评估和元回归以及亚组分析。
纳入的 24 项研究共纳入 4662 例患者。根据 C-MYC 异常的性质（基因、蛋白和 mRNA），将研究分为几个亚组。对于 C-MYC 基因异常的 DLBCL 患者，与无 C-MYC 基因异常的患者相比，OS 的合并 HR 为 2.22（95%置信区间，1.89-2.61），EFS 的合并 HR 为 2.29（95%置信区间，1.81-2.90）。对于 C-MYC 蛋白和 C-MYC mRNA 过表达的 DLBCL 患者，OS 的合并 HR 分别为 2.13 和 1.62。C-MYC 异常在 DLBCL 中其他已知的预后因素中似乎发挥独立作用。添加利妥昔单抗并不能克服 C-MYC 带来的不良预后。
本系统评价和荟萃分析证实了 C-MYC 异常的预后价值。对 C-MYC 的筛查对 DLBCL 的分层具有明确的预后意义，从而保证更个体化的治疗。
