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目的探讨弥漫大B细胞淋巴瘤(DLBCL)患者免疫学标记的预后价值,以及利妥昔单抗对免疫组化标记预后意义的影响。方法回顾性分析2004年2月至2012年10月在新疆自治区人民医院168例初治DLBCL患者病例资料,进行国际预后指标(IPI)评分,根据治疗方案分为化疗组73例及免疫化疗组95例,并通过免疫组织化学方法将两组患者分别分成GCB亚型和non-GCB亚型,比较免疫学亚型、bcl-2、ki-67、IPI评分等指标评估两组患者的预后意义。结果 (1)化疗组及免疫化疗组5年OS率分别为50.7%、68.4%,差异有统计学意义(P<0.01)。(2)免疫化疗组中non-GCB亚型5年OS率显著优于化疗组non-GCB亚型(P=0.01),但两组GCB亚型5年OS差异无统计学意义(P=0.504)。(3)Cox多因素分析结果显示,两组ki-67、IPI评分是OS的独立预后因素(P<0.05)。(4)生存分析显示,化疗组non-GCB亚型中bcl-2阳性组较bcl-2阴性组预后差,差异有统计学意义(P=0.047),而其他各亚型bcl-2阳性组与bcl-2阴性组OS率差异无统计学意义。结论各种免疫标记的结合能够协助评价DLBCL预后,并指导治疗。利妥昔单抗可以显著提高non-GCB亚型伴bcl-2阳性患者的疗效。
Objective To investigate the prognostic value of immunological markers in patients with diffuse large B cell lymphoma (DLBCL) and the effect of rituximab on the prognostic significance of immunohistochemical markers. Methods The data of 168 patients with newly diagnosed DLBCL in People’s Hospital of Xinjiang Uygur Autonomous Region from February 2004 to October 2012 were retrospectively analyzed. The international prognostic indicators (IPI) were scored and divided into chemotherapy group (73 cases) and immunotherapy group (95) The patients were divided into GCB subtype and non-GCB subtype by immunohistochemical method. The prognostic significance of the two groups was evaluated by comparing immunological subtypes, bcl-2, ki-67 and IPI score. Results (1) The 5-year OS rates in chemotherapy group and immunochemotherapy group were 50.7% and 68.4%, respectively, with significant difference (P <0.01). (2) The 5-year OS rate of non-GCB subtype in immunotherapy group was significantly better than non-GCB subtype of chemotherapy group (P = 0.01), but there was no significant difference in the 5-year OS of GCB subtype between the two groups (P = 0.504 ). (3) Cox multivariate analysis showed that the Ki-67 and IPI scores of two groups were independent predictors of OS (P <0.05). (4) Survival analysis showed that the prognosis of bcl-2-positive group was significantly lower than that of bcl-2-negative group in non-GCB subtype of chemotherapy group (P = 0.047) There was no significant difference in OS rates between bcl-2 negative group and bcl-2 negative group. Conclusion The combination of various immune markers can help evaluate the prognosis of DLBCL and guide the treatment. Rituximab significantly improved the efficacy of non-GCB subtypes with bcl-2-positive patients.