Kramer M H, Hermans J, Parker J, Krol A D, Kluin-Nelemans J C, Haak H L, van Groningen K, van Krieken J H, de Jong D, Kluin P M
Department of Pathology, Leiden University Hospital, The Netherlands.
J Clin Oncol. 1996 Jul;14(7):2131-8. doi: 10.1200/JCO.1996.14.7.2131.
We studied the prognostic significance of bcl2 and p53 protein expression in relation to clinical and pathologic characteristics in patients with diffuse large B-cell lymphoma (LCL).
Three hundred seventy-two patients with LCL were retrieved from a population-based registry for non-Hodgkin's lymphoma (NHL). bcl2 and p53 protein expression was studied on paraffin-embedded tumor tissue by immunohistochemistry in relation to clinical factors. Response to therapy and survival were analyzed in 165 patients who were uniformly staged and treated and for whom all prognostic data were available according to the International Prognostic Index (IPI).
Forty-five percent of tumors showed strong expression of the bcl2 protein (bcl2++), with a higher frequency in patients with primary nodal involvement. Disease-free survival (DFS) was significantly better in bcl2-negative/intermediate (bcl2-/+) cases as compared with bcl2++ cases (P = .0011). At 5 years, bcl2-/+ patients showed a DFS rate of 74%, in contrast to bcl2++ patients with a DFS rate of 41% (P = .002). Bcl2 was the strongest independent prognostic value in a multivariate analysis, with a relative risk (RR) of 3.0 in comparison to p53 expression and the clinical factors of the IPI. Overall survival (OS) was not significantly influenced by bcl2 protein expression. p53 protein expression was found in 13% of cases, with a higher frequency in patients with extensive disease. p53 expression did not influence the chance to achieve complete remission (CR) and survival.
bcl2 protein is frequently expressed in LCL and is a strong independent prognostic factor for DFS. p53 expression is related with high tumor burden, but is not an independent risk factor for CR and survival.
我们研究了弥漫性大B细胞淋巴瘤（LCL）患者中bcl2和p53蛋白表达与临床及病理特征的预后意义。
从基于人群的非霍奇金淋巴瘤（NHL）登记处检索出372例LCL患者。通过免疫组织化学研究石蜡包埋肿瘤组织中bcl2和p53蛋白表达与临床因素的关系。对165例分期一致且接受治疗的患者进行了治疗反应和生存分析，这些患者根据国际预后指数（IPI）可获得所有预后数据。
45%的肿瘤显示bcl2蛋白强表达（bcl2++），在原发淋巴结受累患者中频率更高。与bcl2++病例相比，bcl2阴性/中等（bcl2-/+）病例的无病生存期（DFS）显著更好（P = 0.0011）。5年时，bcl2-/+患者的DFS率为74%，而bcl2++患者的DFS率为41%（P = 0.002）。在多变量分析中，bcl2是最强的独立预后价值因素，与p53表达及IPI的临床因素相比，相对风险（RR）为3.0。总生存期（OS）未受bcl2蛋白表达的显著影响。13%的病例中发现p53蛋白表达，在广泛病变患者中频率更高。p53表达不影响实现完全缓解（CR）和生存的机会。
bcl2蛋白在LCL中频繁表达，是DFS的强独立预后因素。p53表达与高肿瘤负荷相关，但不是CR和生存的独立危险因素。
