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目的 探讨原发性结内弥漫性大B细胞淋巴瘤(N DLBCL)的预后相关因素。方法收集51例原发于结内的弥漫性大B细胞淋巴瘤,总结其临床资料和组织病理学特征,用免疫组织化学LSAB法(S P法)研究其免疫表型,使用的抗体有CD20、CD79α、CD45RO、CD3、Bcl 2、Ki 67、CD30、CD15、κ、λ、CyclinD1、TdT、GFAP、CK、MPO等。对每例患者进行随访观察,并进行存活分析。结果 51例DLBCL被重新分型:中心母细胞性变型(CB) 40例,B免疫母细胞性变型(B IB) 3例,富于T细胞或组织细胞性变型(T/HCRBCL)1例,B细胞性间变性大细胞性变型(B ALCL)2例,浆母细胞性变型1例,无法分类4例。Bcl 2阳性表达24例(47. 1% )。Ki 67指数中位数50. 0%, 35例(68. 6% )≥40. 0%。有随访资料的35例存活分析表明, 2年和5年生存率分别为48. 5%和35. 3%,国际预后指数(IPI)≥3比IPI<3的患者5年生存率低(P<0. 01 ),有B症状比无B症状的患者5年生存率低(P<0. 05),Ki 67指数≥40. 0%比<40. 0%的患者5年生存率低(P<0. 05),BCL 2表达和不表达的患者5年生存率差异无统计学意义(P>0. 05)。结论 IPI、B症状、Ki 67指数可以作为DLBCL患者的预后因素,而Bcl 2不是预后因素。
Objective To investigate the prognostic factors of primary nodular diffuse large B cell lymphoma (N DLBCL). Methods Fifty-one patients with diffuse large B-cell lymphoma were collected from the nodules. The clinical data and histopathological features were summarized. The immunophenotypes were studied by immunohistochemistry (SP method). The antibodies used were CD20, CD79α, CD45RO, CD3, Bcl 2, Ki 67, CD30, CD15, κ, λ, CyclinD1, TdT, GFAP, CK, MPO and the like. Each patient was followed up and analyzed for survival. Results 51 cases of DLBCL were reclassified: 40 cases of centroblastic variant (CB), 3 cases of B immunoblastic variant (BIB), 1 case of T cell or histiocytic variant (T / HCRBCL) B cell Amyloidosis (B ALCL) in 2 cases, plasmablast variant in 1 case, can not be classified in 4 cases. Bcl 2 positive expression in 24 cases (47.1%). Ki 67 index median 50.0%, 35 cases (68.6%) ≥ 40.0%. Survival analysis of 35 patients with follow-up data showed a 2-year and 5-year survival rates of 48.5% and 35.3%, respectively, and a 5-year survival rate of patients with an International Prognostic Index (IPI)> 3 over IPI <3 <0.01). The 5-year survival rate was significantly lower in patients with B symptoms than those without B symptoms (P <0.05), with Ki 67 index ≥40.0% vs. <40.0% patients had a lower 5-year survival rate P <0.05). There was no significant difference in 5-year survival rate between patients with and without BCL 2 expression (P> 0.05). Conclusions IPI, B symptoms and Ki 67 index can be used as prognostic factors for DLBCL patients, while Bcl 2 is not a prognostic factor.