CD5和B细胞淋巴瘤/白血病蛋白-2对老年弥漫大B细胞淋巴瘤患者预后的影响

Prognostic significance of CD5 and B cell lymphoma/leukemia protein-2 in the elderly patients with diffuse large B cell lymphoma

摘要:

目的 探讨CD5和B细胞淋巴瘤/白血病蛋白-2(Bcl-2)对老年弥漫大B细胞淋巴瘤(DLBCL)患者预后的影响。方法 回顾性分析2007年1月至2013年12月空军军医大学西京医院血液内科被诊断为DLBCL、年龄＞60岁的患者35例,对入选患者进行2年随访。收集入选患者临床病理资料及治疗预后信息,免疫组织化学检测CD5、Bcl-2表达,并分别根据CD5、Bcl-2是否为阳性表达(以肿瘤细胞染色阳性＞30%)、中枢神经累及与否以及肿瘤临床分期对患者进行分组,并比较各组患者间生存情况。采用SPSS 22.0统计软件对数进行分析。组间比较采用Fisher精确检验法。应用Kaplan-Meier法绘制生存曲线,Log-Rank法进行曲线间单因素分析；多因素分析采用Cox回归模型。结果 研究最终有3 例失访,失访率8.6%。入选患者CD5阳性率为21.9%(7/32),Bcl-2阳性率为46.9%(15/32),CD5及Bcl-2共阳性15.6%(5/32)。21.9%(7/32)患者出现中枢累及。10例患者为肿瘤临床Ⅲ期,22例为临床Ⅳ期。患者中位总生存期(OS)为24个月,中位无进展生存期(PFS)为18个月。1年生存率为96.9%(31/32),2年生存率为71.9%(23/32)。单因素分析显示,与CD5-和Bcl-2-患者比较,CD5⁺和Bcl-2⁺患者OS和PFS均较低(P<0.05)；临床Ⅲ期及Ⅳ期患者PFS(P=0.055)及OS(P=0.076)比较差异均无统计学意义；与无中枢累及患者相比,中枢累及患者OS和PFS较低(均为P=0.004)。另外,CD5⁺患者中枢累及率显著大于CD5-患者(57.1% vs 12.0%；P=0.026),Bcl-2⁺患者中枢累及率显著大于Bcl-2-患者(40.0% vs 5.9%；P=0.033),差异均有统计学意义。多因素Cox分析显示,CD5阳性为影响DLBCL患者OS的独立危险因素(OR=11.205,95%CI 1.717~73.112；P=0.012)。结论 CD5阳性表达可作为影响老年DLBCL患者预后不良的独立危险因素,对预后判断和未来治疗策略的选择具有重要的临床价值。

Abstract:

Objective To investigate the prognostic significance of CD5 and B cell lymphoma/leukemia protein-2 (Bcl-2) in the elderly patients with diffuse large B cell lymphoma (DLBCL). Methods A retrospective cohort study was carried out on 35 patients(＞60 years old) who were diagnosed as DLBCL at Department of Hematology of Xijing Hospital from January 2007 to December 2013. The patients were followed up for 2 years. The clinicopathological data and prognosis were recorded, and the expression of CD5 and Bcl-2 was detected by immunohistochemistry. Patients were divided into groups according to the positive expression of CD5 and Bcl-2 (positive tumor cell >30%), central nervous system (CNS) involvement or not, clinical stage of the tumor, and survival of each group was compared. SPSS statistics 22.0 was used for data processing, Fisher test for intergroup comparison, Kaplan-Meier method for the survival curve, Log-Rank method for single factor analysis between the curves, and Cox regression model for multivariate analysis.Results Three cases were lost with a loss rate of 8.6%. The positivity rate were 21.9%(7/32) for CD5,6.9%(15/32) for Bcl-2 and 15.6%(5/32) for both. CNS involvement was found in 21.9%(7/32) patients. The tumor was stage Ⅲ in 10 patients and stage Ⅳ in 22 patients. The median overall survival (OS) was 24 months, and median progression free survival (PFS) was 18 months.The 1-year survival rate was 96.9%(31/32) and 71.9%(23/32) for 2 years. Univariate analysis showed that OS and PFS were lower in CD5⁺ and Bcl-2⁺ patients (P<0.05) than CD5- and Bcl-2- patients, but no significant difference was found between the patients at Stage Ⅲ and those at Stage Ⅳ in PFS (P=0.055) and OS (P=0.076). In addition, the rate of CNS involvement was significantly higher among CD5⁺ patients than that of CD5- patients (57.1% vs 12.0%; P=0.026), and significantly higher among Bcl-2⁺ patients than that of Bcl-2- patients (40.0% vs 5.9%; P=0.033). Multivariate Cox analysis showed that CD5⁺ was an independent risk factor for OS in patients with DLBCL (OR=11.205,5%CI 1.717-73.112; P=0.012). Conclusion CD5⁺ can be an independent risk factor for poor prognosis of the elderly DLBCL patients. It is of important clinical value for the prognosis and the choice of future treatment strategies.