Park Mi-Jung, Park Soon-Ho, Park Pil-Whan, Seo Yiel-Hea, Kim Kyung-Hee, Seo Ja-Young, Jeong Ji-Hun, Kim Moon Jin, Ahn Jeong-Yeal, Hong Junshik
Department of Laboratory Medicine, Gachon University Gil Medical Center, Incheon, Korea.
Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea.
J Clin Pathol. 2015 Sep;68(9):733-8. doi: 10.1136/jclinpath-2014-202656. Epub 2015 May 21.
Previous studies have suggested many prognostic factors in diffuse large B-cell lymphoma (DLBCL), but the prognostic importance of cell-of-origin and discordant bone marrow involvement remains unclear. The aim of this study was to evaluate the prognostic impact of bone marrow involvement histological subtype, cell-of-origin subtype and international prognostic index (IPI) scores in patients with DLBCL.
Patients who were newly diagnosed with DLBCL and treated with rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) were analysed. Clinical information was reviewed retrospectively. Patients were classified into negative, concordant and discordant bone marrow involvement by histological review. The cell-of-origin types were defined using immunohistochemical analysis.
Both concordant and discordant bone marrow involvement had a negative prognostic impact on progression-free survival, independent of the standard and National Comprehensive Cancer Network (NCCN) IPI scores and cell-of-origin. Patients with non-germinal centre B-cell type showed significantly shorter progression-free survival than those with germinal centre B-cell type. However, non-germinal centre B-cell type did not have a prognostic impact on progression-free survival or overall survival after controlling for the standard and NCCN-IPI and bone marrow involvement.
Both concordant and discordant bone marrow involvement had an adverse prognostic impact on progression-free survival and overall survival; this was independent of the standard and NCCN-IPI and cell-of-origin (non-germinal centre B-cell type). The NCCN-IPI had more powerful prognostic value than the standard IPI (sIPI). The non-germinal centre B-cell type lost significant prognostic impact on progression-free survival after adjustment for standard and NCCN-IPI and bone marrow involvement.
既往研究已提出弥漫性大B细胞淋巴瘤（DLBCL）的多种预后因素，但起源细胞和不一致的骨髓受累的预后重要性仍不明确。本研究的目的是评估骨髓受累组织学亚型、起源细胞亚型和国际预后指数（IPI）评分对DLBCL患者的预后影响。
分析新诊断为DLBCL并接受利妥昔单抗联合环磷酰胺、阿霉素、长春新碱和泼尼松（R-CHOP）治疗的患者。回顾性审查临床信息。通过组织学检查将患者分为骨髓受累阴性、一致和不一致组。使用免疫组织化学分析定义起源细胞类型。
一致和不一致的骨髓受累对无进展生存期均有负面预后影响，独立于标准和美国国立综合癌症网络（NCCN）IPI评分及起源细胞。非生发中心B细胞型患者的无进展生存期明显短于生发中心B细胞型患者。然而，在控制标准和NCCN-IPI及骨髓受累后，非生发中心B细胞型对无进展生存期或总生存期无预后影响。
一致和不一致的骨髓受累对无进展生存期和总生存期均有不良预后影响；这独立于标准和NCCN-IPI及起源细胞（非生发中心B细胞型）。NCCN-IPI比标准IPI（sIPI）具有更强的预后价值。在调整标准和NCCN-IPI及骨髓受累后，非生发中心B细胞型对无进展生存期失去显著预后影响。
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