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동일한 국제예후지표(International Prognostic Index)를 나타내는 미만성 대형 B-세포 림프종에서 Bcl-2와 p16의 임상적 중요성
박상은,박수진,곽승근,박남숙,천재민,윤환중,조덕연,김삼용,김진만 충남대학교 의학연구소 2003 충남의대잡지 Vol.30 No.2
In Korea, malignant lymphoma is a common cancer, comprising about 2.7% of all malignant neoplasm. Diffuse large B cell lymphoma is the most common lymphoma, representing about 50% of all Non-Hodgkin's lymphoma. Diffuse large B-cell lymphoma is usually considered as heterogeneous group of neoplasms rather than a single clinicopathological entity. Clinical prognostic systems, including the International Prognostic Index (IPI), although useful to assess overall prognosis, embrace patients with heterogeneous prognoses. But International Prognostic Index scoring system is not sufficiently predict the prognosis. It is likely that the prognostic assessment of patients with diffuse large B-cell lymphomamight be improved by using biological features. Bcl-2 protein and p16 protein expression is recognized as useful biologic markers predicting the prognosis of patients with diffuse large B-cell lymphoma. To determine the clinical significance and prognostic value of bcl-2 and p16 proteins expression patterns, we studied 18 patients with de novo DLBL, whose archival pathology specimen were available for immunohistochemistry studies, atChungnam National University Hospital from September 1992 to December 2000. Archival specimens from each patient were immunostained with respective antibodies for bcl-2, p16. The results are as follows; 1) The median age was 54(rage : 37-69). There were 12 male patients(66.7%) and 6 female patients(33.3%) The 'B' symptom was abscentin all patients. The stages were as follows : Ⅰ, 2 patient(11.1%), Ⅱ, 10 patient(55.6%), Ⅲ, 4patient(22.2%) and Ⅳ, 2patient(11.1%). 3 patients(16.8%) had the elevated LDH level, 14 patients(77.8%) had the normal LDH level and 1 patients(5.6%) was not identified the LDH level. 2 patients(11.1%) had the bulky disease and 16 patients(88.7%) had no bulky diease. The distribution of ECOG status were O, 2 patients(11.1%c), 1, 14patients(77.8%) and 2, 2patients(11.1%). 2) Theimmunohistochemistry results are as follows bcl-2:+,10 patients(55.6%), bcl-2:-, 8patinets(44.4%), p16:+,3 patients(16.7%), p16:-, 15patients(83.3%) 3) After a median follow UP durations of 67 months, the median survival time was 57 months with a rage of 7-100+ months. 5-years overall survival rates was 44% by Kaplan-Meier method. 4) Reduced overall survival was demonstrated in the patients who expressed bcl-2 protein(P=0.0174). 5-year overall survivial rate was 12%(bcl-2 expression) versus 88%(no bcl-2 expression) 5) Among diffuse large B-cell lymphoma patients with IPI score 0-1, reduced overall survival was demonstrated with bcl-2 expression(P=0.023). 5-year overall survival rate was 18%(bcl-2 expression group) versus 100%(no bcl-2 expressiongroup) 6) Median survival durtation of diffuse large B-cell lymphoma patients negative for p16 expression was 57 months whereas p16 postive patients' median survival duration was not reached(P=0.4478). In diffuse large B-cell lymphoma patients with identical IPI scores, bcl-2 expression had additional prognostic value.
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