Maeshima Akiko Miyagi, Taniguchi Hirokazu, Toyoda Kosuke, Yamauchi Nobuhiko, Makita Shinichi, Fukuhara Suguru, Munakata Wataru, Maruyama Dai, Kobayashi Yukio, Tobinai Kensei
Department of Pathology, National Cancer Centre Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Department of Hematology, National Cancer Centre Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Br J Haematol. 2016 Sep;174(6):923-31. doi: 10.1111/bjh.14153. Epub 2016 Jul 27.
This study analysed incidence, patient outcome, immunophenotype and prognostic factors of histological transformation (HT) from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) to diffuse large B-cell lymphoma (DLBCL) in 467 patients (median age, 61 years). The primary sites of MALT lymphoma were the stomach (43%), ocular adnexa (25%), lung (8%), systemic (8%) and other tissues (16%). HT occurred in 8% of MALT lymphomas. Risk of HT by 15 years was 5%: 4% in limited-stage diseases (n = 385) and 16% in advanced-stage diseases (n = 56) (P = 0·02). The median time to HT was 48 months (range, 4-139). Five-year progression-free survival (PFS) and overall survival (OS) rates after HT were 80% and 94%, respectively. Immunohistochemical results of DLBCL were as follows: germinal centre B-cell (GCB)/non-GCB, 37%/63%; CD10, 9%; BCL6, 59%; MUM1, 38%; MYC, 42%; BCL2, 35%; Ki67 ≥ 90%, 23%; and CD5, 3%. The majority (75%, 9/12) of GCB-type DLBCLs exhibited CD10(-) , BCL6(+) and MUM1(-) immunophenotypes; the remainder had CD10(+) immunophenotypes. Multivariate analysis revealed that only advanced stage at HT was a significant adverse factor for PFS (P = 0·037). Thus, overall risk of HT was low and prognosis after HT was favourable; however, in advanced-stage cases, risk of HT was relatively high and prognosis was unfavourable.
本研究分析了467例（中位年龄61岁）黏膜相关淋巴组织结外边缘区B细胞淋巴瘤（MALT淋巴瘤）转化为弥漫性大B细胞淋巴瘤（DLBCL）的组织学转化（HT）的发生率、患者结局、免疫表型及预后因素。MALT淋巴瘤的原发部位为胃（43%）、眼附属器（25%）、肺（8%）、全身（8%）和其他组织（16%）。8%的MALT淋巴瘤发生了HT。15年时HT的风险为5%：局限期疾病（n = 385）为4%，晚期疾病（n = 56）为16%（P = 0.02）。HT的中位时间为48个月（范围4 - 139个月）。HT后5年无进展生存（PFS）率和总生存（OS）率分别为80%和94%。DLBCL的免疫组化结果如下：生发中心B细胞（GCB）/非GCB，37%/63%；CD10，9%；BCL6，59%；MUM1，38%；MYC，42%；BCL2，35%；Ki67≥90%，23%；CD5，3%。大多数（75%，9/12）GCB型DLBCL表现为CD10（-）、BCL6（+）和MUM1（-）免疫表型；其余具有CD10（+）免疫表型。多变量分析显示，仅HT时的晚期是PFS的显著不良因素（P = 0.037）。因此，HT的总体风险较低，HT后的预后良好；然而，在晚期病例中，HT的风险相对较高且预后不良。
