| Background and ObjectivePeripheral T-cell lymphoma-unspecified(PTCL-U)type is a disease that requires the exclusion of PTCL-specific subtypes such as anaplastic large cell lymphoma(ALCL),angioimmunoblastic T-cell lymphoma(AITL),NK/T cell lymphoma(NKTCL),etc.specific PTCL subtypes,and need to exclude,in Europe and the United States accounts for about 7% of non-hodgkin’s lymphoma(NHL),in Asian countries accounted for about 15 to 22% of the NHL,have heterogeneity on biology and clinical manifestation,its high malignant degree and prognosis is poor,the 5-year survival rate of 25 ~ 45%.When patients’ prognosis is distinguished based on IPI/aaIPI or PIT score,the prognosis of patients with the same risk stratification is not the same,and the combination of clinical and molecular pathological indexes is needed to better distinguish the prognosis of patients.CD30 is normally not expressed under normal human conditions.Pathologically,it can be expressed in tumors,infections and autoimmune diseases,and the positive rate can indicate the malignancy and inflammatory activity of tumors.In terms of treatment,molecular targeted therapy blocks tumor growth and spread by interfering with specific molecules involved in tumor growth and progression.Compared with traditional chemotherapy drugs,stronger selectivity of molecular targeted therapy,toxic spectrum is relatively narrow,toxic effects to a lesser degree,in the basis of biomarkers to select,molecular targeted therapy is better than the effect of cytotoxic drugs.CD30 antigen,a transmembrane glycoprotein of tumor necrosis factor receptor(TNFR)superfamily,plays a multi-effect role in cell growth and survival after stimulation,and is an important histochemical marker for the clinical diagnosis of Hodgkin lymphoma(HL)and ALCL.Reviewing previous literatures,it was found that CD30 is an important target of molecular therapy.In 2011,the US Food and Drug Administration approved the use of CD30 monoclonal antibody Brentuximab vedotin for HL and ALCL based on clinical trial data,and the data showed that the efficacy of the indications was very high.In view of the fact that there is no effective treatment for PTCL-U,the biological significance of CD30 expression in PTCL-U has gradually attracted attention.In this study,we retrospectively analze the expression of CD30 in PTCL-U in positive rate,clinical data and pathological indicators,and evaluate the difference in survival of CD30 expression and its correlation with prognosis.It provides a reference for the application of CD30 targeted drug BV in PTCL-U.Materials and MethodsClinical and pathological indicators and treatment methods of 65 patients with PTCL-U who were newly treated in the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2017 were collected.The relationship between the expression of CD30 in PTCL-U and the difference of CD30 expression in survival and prognosis was analyzed.SPSS17.0 statistical software was used for analysis,chi-square test was used for classification variables,kaplan-meier method was used for survival analysis,and log-rank test was used for comparison of survival rates between the two groups.Univariate analysis was performed on the clinical and pathological indicators affecting survival,and COX proportional risk regression model analysis was performed on the indicators with statistical significance.P<0.05 was taken as the test level.Results1.Patient characteristics and survival The median age of 65 patients with PTCL-U was 60 years old(16-79 years old),72.3% of patients were stage III-IV,23.1% had extranodal involvement ≥2,41.5% had B symptoms,16.9% had bone marrow infiltration,16.9% had ECOG≥ 2 points,56.9% had elevated LDH levels,47.7 % had elevated β2-MG,18.5% had Ki-67≥80,26.2% of patients were EBER positive,and 56.7% of patients were in the middle-high risk group of IPI risk stratification;among the 60 evaluable patients,total The reaction rate is 56.7%.The statistical results of 1-year,3-year and 5-year OS rates were 71%,38% and 22%,respectively.The mOS time was 30 months.PFS rate at 1,3,and 5 years was 47%,28%,and 18%,respectively,with a median PFS of 12 months and 26 months.2.Expression of CD30 in each variable The positive rate of CD30 was 40%(26/65),and CD30 positive was mostly expressed in advanced patients(P=0.017),the LDH level of the positive patients was significantly increased(P=0.032),the expression was higher in ki-67≥80(P=0.009),the CD30 positive expression was more in the number of involved extrapexal lesions 2(P=0.003),and the rate of poor initial treatment was higher(P=0.014).The positive expression of CD30 in two different risk stratification assessment systems of IPI/aaIPI or PIT was more common in medium-high risk patients(IPI/aaIPI,P=0.002;PIT,P=0.020),the expression of CD30 showed no statistical differences in gender,age,B-symptom,physical status,bone marrow infiltration,β2-MG,and EBER.3.Effect of CD30 on survival The 3-year OS rates of the CD30 positive group and the CD30 negative group were 17.4% and 50.4%,respectively(P=0.001).The median OS of the positive group was 12 months,and that of the negative group was 41 months,and the 3-year PFS rate was14.4% and 38.7%(P=0.02),respectively.The mPFS was 7 months in the positive group and 25 months in the negative group.In terms of risk stratification comparison,there was no statistical difference in the survival effect of CD30 expression on IPI/aaIPI in the low-medium risk group and the medium-high risk group.There was no statistically significant difference in the survival effect of CD30 expression in PIT low-medium risk group,and in PIT medium-high risk group,the 2-year OS rate was lower in CD30-positive patients(2-year OS: 17.6% vs.42.9%,P=0.046),but no statistically significant difference in the effect of CD30 on PFS.The 2-year OS rate was lower in CD30 positive patients receiving CHOP regimen(32.7% vs.70.6%,P=0.037),and there was no significant difference in PFS.In the gemcitabine-containing chemotherapy regimen,the expression of CD30 had no significant effect on the survival and prognosis of the patients.4.PTCL-U prognostic factor analysis Univariate analysis showed that late stage(P=0.015),CD30 expression(P=0.019),medium-high risk(P=0.001)and medium-high risk(P=0.002)of IPI/aaIPI were the prognostic risk factors.COX model multivariate analysis showed that PIT and IPI/aaIPI were independent risk factors for OS prognosis(PIT,P=0.009).IPI/aaIPI,P=0.020),PIT is an independent risk factor for PFS prognosis(P=0.000).Conclusion1.CD30 positive expression is more in advanced disease,high LDH level,high proliferation index,medium-high risk group,and the positive group is more likely to involve extranodal disease,and the objective remission rate is lower,the expression rate of CD30 in PTCL-U is low,survival prognosis of the positive expression group is poo2.Stage,CD30,IPI/aaIPI and PIT were the prognostic factors of PTCL-U patients. |
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