摘要目的 探讨弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)的免疫学分型与预后的关系.方法 用Hans、Choi和Tally三种免疫学分型法则对148例华东地区DLBCL病例进行免疫学分型,比较三种法则的免疫学分型结果与临床特征及生存资料的关系,并用Cox比例风险回归模型对本组病例进行临床特征及免疫学分型等多因素生存分析.结果 148例DLBCL三种法则分型结果得到的生发中心B细胞样(germinal center B-cell-like,GCB)亚型显著低于非GCB(non-GCB)/活化B细胞样(activated B-cell-like,ABC)亚型(P＜0.05),其中Tally法则得到的GCB亚型数最低.三种法则分型结果完全一致的病例114例(77.0％),其中GCB亚型(19例,16.7％)亦显著低于非GCB/ABC亚型(95例,83.3％;P=0.000 1).80例有随访资料的病例三种分型法则所得到的GCB和非GCB/ABC亚型的5年总体生存(overall survival,OS)率及生存曲线均无明显差异(P＞0.05).三种法则分型结果均显示原发于胃的DLBCL(primary gastric DLBCL,PG-DLBCL)的GCB亚型数倾向高于其他组别,PG-DLBCL的5年OS率及生存曲线也倾向好于其他组别.Cox多因素生存模型分析发现,年龄(HR=1.036,P=0.001)及分期(HR=1.997,P=0.000)对患者生存期有显著影响,年龄越大及分期越高患者死亡风险增加,然而三种法则分型结果均对患者生存期无明显影响.结论 Hans、Choi和Tally三种免疫学分型法则均不能有效地对华东地区DLBCL进行预后相关分组.PG-DLBCL的免疫表型及临床预后可能不同于其他部位DLBCL.

abstractsObjective To study the immunohistochemical classification and prognosis of diffuse large B-cell lymphoma (DLBCL).Methods A total of 148 cases of DLBCL were classified into germinal center B-cell-like (GCB) and non-GCB/activated B-cell-like (ABC) subtypes by Hans,Choi and Tally immunohistochemical stain algorithms.The clinical features and survival data of GCB and non-GCB/ABC subtypes were compared.Multivariate analysis about clinical features and results of immunohistochemical stain algorithms was carried out by using Cox regression,with overall survival as the outcome.Results The prevalence of GCB subtype was significantly lower than that of non-GCB/ABC subtype,as classified by whichever algorithms in the 148 DLBCL cases studied.The prevalence of GCB subtype by Tally algorithm was lowest.The prevalence of GCB subtype (19 cases,16.7％) was also significantly lower than non-GCB/ ABC subtype (95 cases,83.3％ ; P =0.000 1) in the 114 (77.0％) concordant cases by the three algorithms.There was no difference between GCB and non-GCB/ABC subtypes by the three algorithms in five-year overall survival rate and survival curve of the 80 DLBCL patients with follow-up data available (P ＞ 0.05).Primary gastric DLBCL tended to show a higher prevalence of GCB subtype,a better five-year overall survival rate and survival curve than the other groups.Multivariate analysis showed that patient age (HR=1.036,P =0.001) and tumor stage (HR =1.997,P =0) were also significantly adverse predictors of overall survival.Conclusion The Hans,Choi and Tally immunohistochemical stain algorithms cannot effectively classify Chinese DLBCL into different prognostic subtypes.Primary gastric DLBCL has different immunophenotype and outcome,as compared with DLCBL in other sites.