摘要目的 了解原发胃肠道弥漫性大B细胞淋巴瘤的免疫分型,并比较Choi、Tally和Hans 分型及其与预后的关系.方法 复习90例原发胃肠道弥漫性大B细胞淋巴瘤患者的临床及病理资料并进行随访,应用Kaplan-Meier法、Log-rank检验和Cox比例风险回归模型对临床资料、实验室检测结果 进行生存分析及单因素和多因素预后分析.免疫表型检测采用EnVision和EliVision法,选用的抗体有CD20、CD3ε、CDl0、bcl-6、MUM-1、CD5、bcl-2、GCET1、FOXP1、LMO2、BLIMP1和Ki-67等.结果 (1)年龄为27～83岁,中位年龄58岁,男女比为1.31:1;胃肿瘤58例,占64.4%(58/90);肠肿瘤32例,占35.6%(32/90).(2)肿瘤细胞均表达CD20抗原,均不表达CD3ε和CD5;CD10、bcl-6、MUM-1(30%/80%阈值)的表达率分别为17.8%(16/90)、75.6%(68/90)、52.2%(47/90)/43.3%(39/90),GCET1、FOXP1、LMO2的表达率分别为50.0%(45/90)、45.6%(41/90)、23.3%(21/90),bcl-2、BLIMP1的表达率分别为42.2%(38/90)、8.9%(8/90),Ki-67阳性指数20%～95%,中位数为80%.Hans分型:51.1%为生发中心B细胞型(GCB型),48.9%为非GCB型;Choi分型:55.6%为GCB型,44.4%为活化B细胞(ABC)型;Tally分型:34.4%为GCB型,65.6%为非GCB型.(3)67.8%(61/90)的患者接受化疗,68.9%(62/90)的患者接受手术.患者的2、3和5年总体生存率分别为58.5%、52.8%和49.8%,CHOP方案(环磷酰胺+多柔比星+长春新碱+泼尼松)治疗组的2、3和5年总体生存率分别为68.5%、61.2%和52.9%.结论 Hans和Choi分型各亚型比例差别不大,Tally分型中非GCB型较GCB型比例增高.三种分型的各亚型均存在GCB型优于非GCB/ABC型的趋势.Log-rank检验单因素分析提示乳酸脱氢酶(LDH)水平、国际预后指数(IPI)、化疗、手术、B症状、病变数量、临床分期对预后有影响.Cox比例风险回归模型多因素分析提示Hans分型、Choi分型、化疗、手术、LDH和Lugano分期是独立的预后因素.

abstractsObjective To study the immunophenotype and prognostic significance of primary gastrointestinal diffuse large B-cell Iymphoma, with reference to Hans, Choi and Tally algorithms. Methods The clinicopathologic features and follow-up data in 90 cases of primary gastrointestinal diffuse large B-cell lymphoma were analyzed by Kaplan-Meier method, Log-rank test and Cox regression model.Immunohistochemistry was carried out using EliVision and EnVision methods for CD20, CD3ε, CD10,bcl-6, MUM-1, CDS, bcl-2, GCET1, FOXP1, LMO2,BLIMP1 and Ki-67. Results The age of patients studied, 64. 4% (58/90) involved the stomach and 35.6% (32/90) involved the intestine. The immunohistochemical findings were as follows: 100% positivity for CD20, 0% for CD3ε and CD5, 17.8% (16/90) for CD10, 75.6% (68/90) for bcl-6, 52. 2% (47/90) for MUM-1 (cut off was 30%), 43.3%(39/90) for MUM-1 (cut off was 80%), 50.0% (45/90) for GCET1, 45.6% (41/90) for FOXP1,23.3%(21/90) for LMO2, 42.2% (38/90) for bcl-2 and 8.9% (8/90) for BLIMP1. The Ki-67 index ranged from 20% to95% (median =80%). According to Hans algorithm, 51.1% of the cases belonged to germinal center B-cell (GCB) subtype and 48.9% belonged to non-GCB subtype. In contrast, Choi algorithm classified 55.6% cases as GCB subtype and 44. 4% as activated B-cell (ABC) subtype.According to Tally algorithm, 34. 4% were of GCB subtype and 65.6% of non-GCB subtype. Most of the patients (67. 8% ,61/90) received chemotherapy and 68.9% (62/90) underwent surgical resection. The overall 2, 3 and 5-year survival rates were 58. 5%, 52. 8% and 49. 8%, respectively. The overall 2, 3 and 5-year survival rates in the CHOP therapy group were 68.5%, 61.2% and 52. 9%, respectively.Conclusions There is no significant difference in ratio between the GCB and non-GCB/ABC subtypes by Hans and Choi algorithms. The non-GCB subtype seems to be more prevalent according to Tally algorithm.Although there is no significant difference in survival between GCB and non-GCB/ABC subtypes by the 3algorithms, GCB subtype tends to show a better survival. In univariate analysis, LDH level, international prognostic index, chemotherapy, surgical resection, B symptoms, number of involved sites and clinical stage are found to have prognostic significance. In multivariate analysis, Choi algorithm, Tally algorithm,chemotherapy, surgical resection, LDH level and clinical stage are independent prognostic factors.