Bcl-2和Myc共表达与原发性胃肠道弥漫性大B细胞淋巴瘤预后和化疗疗效的相关性研究

Relationship of Bcl-2 and Myc co-expression with chemotherapy efficacy and prognosis in patients with primary gastrointestinal diffuse large B-cell lymphoma

关键词:  Bcl-2  Myc  原发性胃肠道弥漫性大B细胞淋巴瘤  化疗

Key words:  Bcl-2  Myc  primary gastrointestinal diffuse large B-cell lymphoma  chemotherapy

摘要:

目的研究Bcl-2（B-cell lymphoma-2）和Myc基因共表达与原发性胃肠道弥漫性大B细胞淋巴瘤（primary gastrointestinal diffuse large B-cell lymphoma, PGI-DLBCL）预后和化疗疗效间的关系。 方法回顾性分析2001年6月—2021年12月在上海市徐汇区中心医院普外科因标本活检或急诊情况而接受手术治疗的136例PGI-DLBCL患者的临床资料。应用荧光原位杂交技术检测Bcl-2和Myc基因扩增情况，免疫组化检测其蛋白表达，并结合临床参数及预后进行相关性分析。 结果Bcl-2基因扩增阳性33例（24.3%），蛋白阳性表达90例（66.2%）。Myc基因扩增阳性21例（15.4%），蛋白阳性表达75例（55.2%）。Bcl-2、Myc基因共扩增阳性16例（11.8%），Bcl-2、Myc蛋白共表达阳性49例（36.0%）。Bcl-2、Myc基因共扩增与肿瘤原发部位、Ann Arbor分期、IPI评分以及LDH水平有关（P<0.05），Bcl-2、Myc蛋白共表达与肿瘤原发部位、LDH水平以及B症状有关（P<0.05）。Bcl-2、Myc基因共扩增阳性患者生存率低于阴性患者（P<0.01），蛋白共表达与生存无关（P＞0.05）。Bcl-2、Myc共表达患者使用RCHOP方案生存率较CHOP方案有升高趋势，但差异无统计学意义（P＞0.05）。 结论联合检测Bcl-2和Myc基因对PGI-DLBCL的预后和化疗疗效预测有一定的临床意义。

Abstract:

ObjectiveTo investigate the relationship of Bcl-2 and Myc co-expression with chemotherapy efficacy and prognosis in patients with primary gastrointestinal diffuse large B-cell lymphoma(PGI-DLBCL). MethodsClinical data of 136 patients with PGI-DLBCL who underwent surgical treatment in our department from June 2001 to December 2021 were retrospectively analyzed. The gene amplification and protein expression of Bcl-2 and Myc were detected by fluorescence in situ hybridization and immunohistochemistry. The relationship of Bcl-2 and Myc co-expression with chemotherapy efficacy and prognosis of patients was analyzed. ResultsThere 33(24.3%) and 21(15.4%) cases of positive Bcl-2 and Myc gene amplification; and 90 cases(66.2%) and 75 cases(55.2%) of positive protein expression, respectively. Meanwile there were 16 cases(11.8%) of positive co-amplification of Bcl-2 and Myc genes, and 49 cases(36.0%) of positive co-expression of Bcl-2 and Myc proteins. The co-amplification of Bcl-2 and Myc genes was associated with tumor primary site, Ann Arbor staging, IPI score, and LDH level(P<0.05), while the co-expression of Bcl-2 and Myc proteins was associated with tumor primary site, LDH level, and B symptoms(P<0.05). The survival rate of patients with Bcl-2 and Myc gene positive co-amplification was lower than that of patients with negative co-implification(P<0.01); however, Bcl-2 and Myc protein co-expression was not associated with survival of patients(P＞0.05). Patients with Bcl-2 and Myc co-expression receiving RCHOP chemotherapy had a better survival trend compared to CHOP chemotherapy, but there was no significant difference between the two groups(P＞0.05). ConclusionThe co-expression of Bcl-2 and Myc genes has certain clinical significance in predicting the prognosis and chemotherapy efficacy for patients with Bcl-2 and Myc.