High Ki-67 expression in diffuse large B-cell lymphoma patients with non-germinal center subtype indicates limited survival benefit from R-CHOP therapy
High Ki-67 expression in diffuse large B-cell lymphoma patients with non-germinal center subtype indicates limited survival benefit from R-CHOP therapy
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非生发中心亚型弥漫性大 B 细胞淋巴瘤患者中 Ki-67 高表达表明 R-CHOP 治疗的生存获益有限
DOI：
10.1111/j.1600-0609.2012.01778.x
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发表时间：
2012-06-01
影响因子：
3.1
通讯作者：
Guan, Zhong-Zhen
中科院分区：
文献类型：
--
作者：
Li, Zhi-Ming;Huang, Jia-Jia;Guan, Zhong-Zhen
目的：利妥昔单抗显着改善 DLBCL 患者的生存率，尤其是非生发中心 B 细胞样 (non-GCB) 亚型的患者。 Ki-67 表达（增殖指数）对 DLBCL 患者临床结果的影响在很大程度上尚未被探索。本研究旨在探讨Ki-67表达是否是接受标准化疗联合利妥昔单抗治疗的DLBCL患者（尤其是非GCB DLBCL患者）的预后指标。方法：采用免疫组织化学方法检测 118 例新诊断为 DLBCL 并接受 R-CHOP（利妥昔单抗、环磷酰胺、阿霉素、长春新碱和泼尼松）治疗的患者肿瘤标本中 Ki-67 蛋白的表达。结果：Ki-67 高表达患者的总生存率（OS）和无进展生存率（PFS）低于 Ki-67 低表达患者（3 年 OS：65.2% vs. 81.7%，P = 0.030；3 年 PFS：56.4% vs. 73.3%，P = 0.020），GCB 亚型和非 GCB 亚型患者相似（OS：P = 0.330；PFS：P = 0.287）。根据免疫表型亚组的Ki-67表达状况，与其他三个亚组相比，非GCB亚组中Ki-67高表达的患者的PFS和OS最不利（分别为P = 0.004和P = 0.002）。在多变量分析中，Ki-67 高表达的非 GCB 是接受 R-CHOP 治疗的 DLBCL 患者生存较差的独立预后预测因子。结论：对于非 GCB DLBCL 且 Ki-67 高表达的 DLBCL 患者，R-CHOP 治疗的生存获益有限。
Objectives: Rituximab has significantly improved the survival of patients with DLBCL, especially those with non-germinal center B-cell-like (non-GCB) subtype. The impact of Ki-67 expression, an index of proliferation, on the clinical outcomes of patients with DLBCL has largely been unexplored. This study aimed to investigate whether Ki-67 expression is an indicator of outcome in DLBCL patients (especially non-GCB DLBCL patients) treated with standard chemotherapy combined with rituximab. Methods: Expression of Ki-67 protein was examined immunohistochemically in 118 tumor specimens from patients newly diagnosed with DLBCL and treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). Results: Overall survival (OS) and progression-free survival (PFS) were lower in patients with high Ki-67 expression than in those with low Ki-67 expression (3-year OS: 65.2% vs. 81.7%, P = 0.030; 3-year PFS: 56.4% vs. 73.3%, P = 0.020), similar in patients with GCB subtype and those with the non-GCB subtype (OS: P = 0.330; PFS: P = 0.287). According to Ki-67 expression status by immunophenotype subgroups, patients with high Ki-67 expression in non-GCB subgroup had the most unfavorable PFS and OS, comparing with the other three subgroups (P = 0.004 and P = 0.002, respectively). In multivariate analysis, non-GCB with high Ki-67 expression was an independent prognostic predictor of inferior survival in DLBCL patients treated with R-CHOP. Conclusion: For DLBCL patients with non-GCB DLBCL and high Ki-67 expression, the survival benefit from R-CHOP therapy is limited.