摘要目的:探讨C-MYC、bcl-2、bcl-6蛋白的表达与原发性CD5阳性的弥漫性大B细胞淋巴瘤（CD5-positive diffuse large B cell lymphoma，CD5 +DLBCL）患者临床病理特征之间的关系。 方法:收集2013年2月至2018年9月上海交通大学医学院附属瑞金医院初治诊断为原发性CD5 +DLBCL标本57例，采用HE染色、免疫组织化学技术及荧光原位杂交（FISH）法，检测原发性CD5 +DLBCL中C-MYC、bcl-2、bcl-6蛋白的表达情况，并分析其与临床病理特征之间的关系。 结果:57例原发性CD5 +DLBCL中，男性27例，女性30例，发病年龄35~99岁。C-MYC、bcl-2、bcl-6蛋白表达阳性率分别为50.9%（29/57）、84.2%（48/57）、75.4%（43/57），其中C-MYC和bcl-2双表达阳性率为40.4%（23/57）；其在患者性别、临床分期、血清乳酸脱氢酶（LDH）水平、β2微球蛋白水平、国际预后指数（IPI）评分、B症状、骨髓侵犯和中枢神经系统（CNS）复发等临床特征之间差异无统计学意义（ P>0.05）；单因素生存分析显示：C-MYC阴性患者中位总生存率显著高于阳性患者（ P=0.010），双表达阴性患者中位总生存率显著高于阳性患者（ P=0.008），bcl-6阳性患者中位总生存率显著高于阴性患者，差异具有统计学意义（ P=0.021），bcl-2蛋白表达与预后无明显相关性（ P>0.05）；Cox模型多因素分析显示，C-MYC蛋白表达可作为原发性CD5 +DLBCL患者总生存率的独立预测指标（ P=0.034）。 结论:C-MYC、bcl-2、bcl-6蛋白在原发性CD5 +DLBCL的预后价值中，bcl-2表达对预后无影响，bcl-6阳性组预后较好，C-MYC蛋白表达可作为预测原发性CD5 +DLBCL患者预后的独立有效指标，但对于原发性CD5 +DLBCL患者中，C-MYC、bcl-2及bcl-6蛋白的表达与C-MYC、bcl-2及bcl-6基因重排之间的关系，还有待扩大样本量进一步深入探讨。

abstractsObjective:To investigate the relationship between the protein expression of C-MYC, bcl-2 and bcl-6 and the clinicopathological characteristics in patients with de novo CD5-positive diffuse large B cell lymphoma (CD5 +DLBCL). Methods:Fifty seven cases of de novo CD5 +DLBCL were collected at Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine from February 2013 to September 2018. The hematoxylin-eosin stained slides were reviewed, and immunohistochemical (IHC) staining and FISH were used to analyze the relationship between C-MYC, bcl-2, bcl-6 expression and the clinicopathologic characteristics of patients. Results:Among these 57 cases, 27 were male and 30 were female. The age of onset was 35-99 years old. The IHC expression rates of C-MYC, bcl-2 and bcl-6 were 50.9% (29/57), 84.2% (48/57), and 75.4% (43/57) respectively; and co-expression rate of C-MYC and bcl-2 proteins was 40.4 (23/57). There was no significant correlation between protein expression and patients′ genders, clinical stage, the level of serum LDH,β2 microglobulin, IPI,B symptoms, bone marrow involvement and central nervous system recurrence ( P>0.05). Univariate analysis showed that the median OS of C-MYC negative patients was significantly longer than C-MYC positive patients ( P<0.05); and the median OS of patients without double expression was significantly longer than that of patients with positive expression ( P<0.05), and bcl-6 positive patients had longer median OS than bcl-6 negative patients ( P<0.05). There was no significant correlation between prognosis and bcl-2 protein expression ( P>0.05) . Cox multivariate analysis showed C-MYC protein expression was an independent predictor of OS in de novo CD5 +DLBCL ( P<0.05). Conclusions:Bcl-2 protein expression has no effect on the prognosis in de novo CD5 +DLBCL whereas bcl-6 expression is correlated with good prognosis. C-MYC protein expression could be used as an independent and effective index to predict the prognosis of patients with de novo CD5 +DLBCL.However, the relationship between protein expression and gene rearrangement of C-MYC, bcl-2 and bcl-6 needs to be further explored.