| Summary: | 碩士 === 國立臺灣大學 === 臨床醫學研究所 === 93 === Comparison of the Expression and Prognostic Significance of Differentiation Markers between Diffuse Large B-Cell Lymphoma of Central Nervous System Origin and Peripheral Nodal Origin
Purpose: Whether diffuse large B-cell lymphoma (DLBCL) of primary central nervous system origin (PCNSL) is biologically different from DLBCL of peripheral nodal origin (NL) remains unclear. The purpose of this study was to compare the expression frequency and prognostic significance of a panel of cell differentiation markers between these two disease entities.
Experimental design: This study included HIV-unrelated patients PCNSL (n=51) and NL (n=72) treated at four hospitals in Taiwan for whom archival tumor tissue was available. The lymphomas were morphologically subclassified according to updated Kiel classification criteria. Immunohistochemistry for CD10, BCL-6, MUM-1, vs38c, CD138 and BCL-2 was performed under the same conditions. The prognostic significance of clinical and immunophenotypic markers were evaluated in PCNSL patients that received HD-MTX based chemotherapy (n=29) and in NL patients that received CHOP or CHOP-like regimen (n=65) as first line treatment.
Results: The frequencies of expression (PCNSL vs. NL) for CD10, BCL-6, MUM-1, vs38c, CD138 and BCL-2 were 18% vs. 22% (P = 0.650), 61% vs. 46% (P = 0.200), 84% vs. 53% (P < 0.001), 4% vs. 7% (P = 0.698), 0% vs 0% and 49% vs 51% (P = 0.856) respectively. PCNSL tumors were more frequently classified as non -germinal center B cells (non-GCB) group than NL tumors (P = 0.020; 78% vs. 62%). In PCNSL, univariate analysis demonstrated that patients with BCL-6+ had a trend towards longer survival (P = 0.073; median survival, 25.3 vs. 7.3 months) and multivariate analysis confirmed expression of BCL-6 as an independent prognostic factor (P = 0.026). In NL, univariate and multivariate analyses demonstrated that GCB was significantly associated with longer survival.
Conclusion: Higher frequency of non-GCB classification in PCNSL implies that it has a more differentiated cellular origin than NL. Expression of BCL-6 is an important prognostic factor and its expression is more informative for prognosis in PCNSL than in NL.
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