摘要目的 观察CD21在弥漫性大B细胞淋巴瘤(DLBCL)中的表达,并探讨其与各种临床病理因素及预后的关系.方法 回顾性分析2005年6月至2011年9月吉林大学第一医院诊断明确、病例资料齐全的DLBCL患者的石蜡标本共80例,并且已经应用免疫组织化学(SP法)染色检测了肿瘤组织中 Ki-67、CD20、CD79a、CD3、CD43、CD5、cyclin D1 、bcl-2、CD10、bcl-6、GCET-1、FOXP-1和MUM-1蛋白表达情况.同时检测肿瘤组织中CD21的表达情况.分析CD21的表达情况与各临床因素的关系,各临床因素及CD21与总生存期的关系.结果 年龄≤60岁CD21+患者比例(64.0％,16/25)显著高于 CD21-患者(38.2％,21/55);临床分期为Ⅰ～Ⅱ期CD21+患者的比例(52.0％,13/25)显著高于CD21-患者(23.6％,13/55);结外受累数＜2个CD21+患者比例(68.0％,17/25)显著高于CD21-患者(41.8％,23/55);国际预后指数(IPI)评分为0～2时CD21+患者的比例(68.0％,17/25)显著高于CD21-患者(41.8％,23/55)；CD21+患者为GCB分型的比例(60.0％,15/25)显著高于CD21-患者(23.6％,13/55);CD21+患者因DLBCL导致死亡的比例(32.0％,8/25)显著低于CD21-患者(56.4％,31/55).单因素生存分析显示影响DLBCL患者总生存期的临床病理因素中,年龄、ECOG评分、乳酸脱氢酶(LDH)值、结外受累数、IPI评分、CD21的表达情况、治疗方案和疗效与预后密切相关,差异有统计学意义(P＜0.05).Cox模型多因素分析显示,ECOG评分、LDH值、结外受累数、CD21的表达情况等因素与预后密切相关,差异有统计学意义(P＜0.05).80例患者中CD21+患者的总生存期显著高于CD21-患者(P＜0.01).结论 CD21+的DLBCL患者有发病年龄低,临床分期早,节外受累数少以及IPI评分小的特点.CD21+的DLBCL患者的总生存期及中位生存期均显著高于CD21-患者.CD21的表达情况、ECOG评分、LDH值、结外受累数等因素是DLBCL患者的独立预后因素,CD21的阳性表达对DLBCL患者的预后更有意义.

abstractsObjective To analyze CD21 expression in diffuse large B cell lymphoma (DLBCL) and to explore its relationship with the clinicopathological characteristics and prognosis.Methods The clinical data from 80 DLBCL patients who were treated in First Hospital of Jilin University from June 2005 to September 2011 were retrospectively analyzed.The cases were subjected to immunohistochemical staining (SP method) for Ki-67,CD20,CD79a,CD3,CD43,CD5,cyclin D1,bcl-2,CD10,bcl-6,GCET-1,FOXP-1 and MUM-1 protein expression in the tumor tissue.Immunohistochemistry was also used to detect CD21 expression in the tumor tissue.SPSS 18.0 was used to analyze the relationship between CD21 expression and various clinical factors,and the relationship between various clinical factors including CD21 and overall survival.Results In the patients aged under 60 years,the incidence of CD21+ lymphoma (64.0％,16/25) was significantly higher than that of CD21+ lymphoma (38.2％,21/55).There were more CD21+ lymphoma patients who were at clinical stages Ⅰ-Ⅱ (52.0％,13/25)than patients with CD21 lymphomas (23.6％,13/55).There were also more CD21 + lymphoma patients (68.0％,17/25) having less than two extranodal sites involvement than CD21-lymphoma patients (41.8％,23/55).In addition,there were more CD21 + lymphoma patients with IPI 0-2 (68.0％,17/25) than CD21-lymphoma patients (41.8％,23/55).There were more CD21 + lymphoma patients with GCB subtype (60.0％,15/25) than CD21-lymphoma patients (23.6％,13/55).Death related to DLBCL was less in CD21 + lymphoma patients (32.0％,8/25) than CD21-lymphoma patients (56.4％,31/55).Univariate analysis showed that these clinical pathological characteristics affected the overall survival of DLBCL patients,including age,ECOG score,LDH,extranodal involvement,IPI index,CD21 expression,treatment option and efficacy (P ＜0.05).Cox multivariate analysis showed that ECOG score,LDH,extranodal involvement,CD21 expression were closely related to prognosis,and the difference was statistically significant (P ＜ 0.05).Among the 80 patients,the overall survival (OS) of CD21 + lymphoma patients was significantly higher than that of CD21-lymphoma patients.Conclusions The expression of CD21 is associated with young age at onset,early clinical stage,small number of involvement and low IPI index.The OS and median overall survival of CD21 + lymphoma patients are significantly higher than those of CD21-patients.CD21 expression,ECOG score,LDH,extranodal involvement are independent prognostic factors in DLBCL,and in particular,the expression of CD21 is more significant in the prognosis of DLBCL patients.