| Objective: To retrospective analysis the clinical characteristics,curative effect and survival of diffuse large B-cell lymphoma and to analyze the prognostic factors.To test the expression of Nm23-H1 in patients with diffuse large B-cell lymphoma and to analyze the correlation among Nm23-H1,clinical characteristics and prognosis.Methods:1 375 cases of newly diagnosed diffuse large B cell lymphoma were collected from the fourth hospital of Hebei Medical University from 2012-4 to2016-11.312 patients with relatively complete medical records were selected as the research objects.To record the clinical characteristics of all patients before treatment,including sex,age,Ann Arbor stage,B symptoms,physical status,serum lactate dehydrogenase,?-hydroxybutyrate dehydrogenase,?2-microglobulin,erythrocyte sedimentation rate,C-reactive protein,hemoglobin,serum albumin,IPI score,bone marrow violation,huge mass,the number of lesions involving the outbreak,immunophenotype(GCB or non-GCB type),primary site and Ki-67 expression level.Patients were treated with CHOP-like or CHOP ± R regimen.To summarize the short-term efficacy of patients and to assess the prognostic factors.2 Fifty patients were selected from the above patients as experimental group,which were newly diagnosed from 2012 to 2015,confirmed by immunohistochemistry in the pathology of our hospital,had archive tissues' s wax blocks and no serious complications.Another 10 patients with lymph node hyperplasia were selected as the control group.The expression of Nm23-H1 protein in DLBCL and lymph node hyperplasia was detected by immunohistochemistry.The expression of Nm23-H1 protein was evaluated byFromowitz semi-quantitative grading method.According to the expression intensity,divided the patients into two groups: low expression(-~ +)and high expression(++ ~ +++).The expression of Nm23-H1 protein in different clinical features was analyzed.The correlation between this protein and the prognosis of diffuse large B-cell lymphoma was evaluated.3 SPSS 21.0 software was used for statistical analysis.Correlation analysis used Spearman rank correlation analysis.Kaplan-Meier method was used for single factor survival analysis.Log-rank tests were used to compare survival rates.Multivariate analysis was performed using the Cox proportional hazards model.When P value <0.05 was that the difference has statistically significant.Results:1 Clinical data: Among the 312 patients,there were 160 males and 152females;age > 60 years in 112 patients,age ? 60 years in 200 cases,the median age was 56 years;Ann Arbor stage ?-? in 110 cases,?-? in 202cases;122 cases with B symptoms;32 cases of PS score?2 points;91 cases of elevated LDH;98 cases of elevated ?-HBDH;105 cases of elevated ?2-MG;127 cases of elevated ESR;CRP was high in 120 cases;57 cases of low Hb;83 cases of low ALB;IPI score: 149 cases of low risk,85 cases of low risk,61 cases of high risk,17 cases of high risk;19 cases of severe mass;17 cases of massive lumps;83 patients involving the number of lesions involving ? 2cases;140 cases of GCB type and 172 cases of non-GCB type;Ki-67 positive expression was high expression(?80%)in 170 cases,low expression(<80%)in 142 cases;133 patients treated with rituximab,179 patients were not treated with rituximab.2 In the 312 patients with DLBCL,the effective(CR + CRu + PR)patients were 250 cases,and 62 cases were ineffective(SD + PD),the total objective and effective rate was 80.1%.The efficacy of Ann Arbor stage(?-?)period was better than(?-?)period,the difference was statistically significant(87.3% vs 76.2%,P <0.05).The efficacy of IPI(0-2)score was better than(3-5)point,the difference was statistically significant(84.6% vs66.7%,P<0.05).The efficacy of GCB was better than non-GCB type,but the difference was not statistically significant(85.0% vs 76.2%,P> 0.05).The efficacy of rituximab was better than without,the difference was statistically significant(85.7% vs 76.0%,P <0.05);3 The prognostic factors in the clinical features including age,Ann Arbor staging,B symptoms,serum LDH,?-hydroxybutyrate dehydrogenase,?2-microglobulin,C-reactive protein,hemoglobin,serum albumin,IPI score,immunophenotype,primary site,Ki-67 expression level and the availability of rituximab(P <0.05).The age,serum albumin,immunophenotype,and the availability of rituximab were the independent prognostic factors for the study of 312 patients with DLBCL;4 Immunohistochemical results: The expression of Nm23-H1 in 50 patients was that,5 cases(10%)were negative(-),13 cases(26%)were weak positive(+),21 cases(42%)were moderate positive(++),11 cases(22%)were strong positive(+++),the positive rate was 90%,and 18 cases(36%)were low expression(-~ +),32 cases(64%)were high expression(++ ~ +++).In the 10 cases of lymph node reactive hyperplasia,there were 6 cases(60%)negative,4 cases(40%)weak positive(+),which were weakly expressed of all;5 The expression of Nm23-H1 was not correlated with gender,age,Ann Arbor stage,B symptom,physical status(PS),serum lactate dehydrogenase(LDH),immunological subtype and international prognosis index(IPI),except the expression of Ki-67 protein;6 50 cases of DLBCL patients with chemotherapy(CR + CRu + PR)were 41 cases,ineffective(SD + PD)were 9 cases,the total objective and effective rate of 82%.The recent effect of Nm23-H1 high-expression is lower than that of low expression,but the difference was not statistically significant(75% vs 94%,P>0.05);7 The 3-year overall survival rate(OS)was 88.9% in patients with low expression of Nm23-H1,while it was 53.1% in patients with high expression.Log-Rank test showed that there was significant difference between the two groups(P = 0.005);8 The univariate analysis of statistically significant(P <0.05)prognostic factors included the expression of Nm23-H1,IPI,Ki-67 expression,B symptom,serum LDH level,serum ?-hydroxybutyrate dehydrogenase level,Ann Arbor stage,C-reactive protein,serum albumin level and bone marrow invasion.The multivariate analysis showed that Nm23-H1,albumin,bone marrow infiltration,and IPI were independent prognostic factors.Conclusions:1 The efficacy of Ann Arbor stage(?-?)period was better than(?-?)period in 312 patients.The efficacy of IPI(0-2)score was better than(3-5)point.The efficacy of rituximab was better than without in all of the 312 cases of DLBCL.2 Age,Ann Arbor stage,B symptoms,LDH,?-hydroxybutyrate dehydrogenase,?2-microglobulin,C-reactive protein,hemoglobin,serum albumin,IPI score,immunophenotype,primary site,Ki-67 expression level and rituximab were related to DLBCL patients' prognosis.Multivariate analysis showed that age,serum albumin,immunophenotype and rituximab treatment were independent prognostic factors for patients.3 The expression of Nm23-H1 in 50 cases of diffuse large B-cell lymphoma was significantly higher than that in control group.4 The expression intensity of Nm23-H1 was positively correlated with the expression of Ki-67.The expression of Nm23-H1 was correlated with long-term survival,and the high expression of Nm23-H1 was significantly lower than that of low expression group.5 Combined with single factor and multivariate analysis of 50 patients showed that Nm23-H1 was an independent prognostic factor for DLBCL. |
PDF Full Text Request