Expression Of Myeloid Cell Leukemia-1(mcl-1) In Diffuse Large B Cell Lymphoma And Its Clinical Significance

Objective:The level of mcl-1 expression in DLBCL was detected,and the correlation between the expression of mcl-1 and the clinicopathological indicators of patients were analyzed to understand the role of the expression of mcl-1 in the occurrence,development and prognosis of DLBCL,so as to provide more theoretical basis for the accurate diagnosis,individualized treatment and screening of targeted drugs in DLBCL in the future.Methods:DLBCL lymph paraffin tissue samples of 28 patients was examed by immunohistochemistry for mcl-1 expression,and the correlation between the expression of mcl-1 and clinicopathological indicators in DLBCL patients was analyzed.Results:1.In the pathological sections,mcl-1 showed diffuse brown fine particle staining in the cytoplasm,and a few were granular staining in the perinuclear cytoplasm.In the pathological sections of 28 cases of DLBCL who underwent immunohistochemistry,16 cases were positive for mcl-1,positive rate of 57.1%.Among them,11 cases were strongly positive,accounting for 39.3% of the total and 68.8% of the positive cases.Among the 10 cases of Reactive lymphoproliferative disease(RLD)tissue sections,1 case had positive expression of mcl-1,and the positive rate was 10%.Compared with RLD tissues,the difference was statistically significant(P <0.05);2.There was no correlation between the expression of mcl-1 and gender,age,B symptoms,lymph nodes involvement,extranodal infiltration,Ann Arbor stage,IPI score,pathological typing,level of LDH、β2-microglobulin,expression of Ki-67,etc.(P >0.05).In the initial treatment grouping,the positive rate of mcl-1 was 38.9% in the effective group and 90.0% in the ineffective group,presenting a statistical difference(P =0.016<0.05);3.We discussed the single factor logistic regression analysis about the expression level of mcl-1 predict the DLBCL initial treatment response,the results showed that the mcl-1 expression for the forecast of initial treatment effect OR value = 0.071,OR 95% CI(0.007 0.686),P= 0.02 < 0.05,indicating that mcl-1 expression positive group’s treatment effective probability is 0.071 times that of the negative group,namely the mcl-1 expression positive group for the initial treatment is invalid probability is 14.862 times that of the negative group.At the same time we made the single factor logistic regression analysis about the expression level of the classic antiapoptotic proteins the bcl-2 predict the DLBCL initial treatment response,the results showed that the bcl-2 expression for the forecast of initial treatment effect OR value = 0.214,OR 95% CI(0.040 1.139),P = 0.071 > 0.05,so the cases of this study is based on limited data proved that mcl-1 expression level can be used as a biological predictor of initial treatment of patients with DLBCL,and traditional bcl-2 expression levels cannot;4.In order to analyze the predictive power of simultaneous expression of mcl-1 and bcl-2 to initial treatment response,logistic regression modeling was carried out for the expression of mcl-1,bcl-2 and dual expression.The ROC curve was drawn accordingly,and the results showed that: Area under curve of dual expression(AUC=0.842,P<0.05,sensitivity =0.611,specificity =0.900).The AUC of double expression was larger than that of single factor expression,indicating that the effect of the joint prediction model was better than that of the single prediction model with mcl-1 expression or bcl-2 expression.Conclusions:1.Mcl-1 protein is highly expressed in DLBCL,with a positive rate of 57.1% and a strong positive rate of 39.3%.2.The level of mcl-1 expression in DLBCL was not correlated with gender,age,disease typing,B symptoms,lymph node infiltration,extranodal infiltration,Ann stage,IPI score,pathological typing,level of LDH and β2microglobulin,Ki67 expression,etc.,and was correlated with initial treatment response.Patients with high mcl-1 expression have poor initial response to treatment.3.The expression of mcl-1 protein can be used as a predictor of DLBCL’s response to initial treatment,and those with positive expression of mcl-1 are 14.862 times more likely to be ineffective with initial treatment than those with negative expression.In this study,the expression of bcl-2 could not be used as a predictor of initial treatment response of DLBCL patients.4.Coexpression of bcl-2 and mc L-1 can be used as an independent prognostic factor for poor prognosis of DLBCL patients,Patients with coexpression of bcl-2 and mcl-1 were more likely to be ineffective with initial treatment than those with single expression of mcl-1 or bcl-2.