目的:弥漫大B细胞淋巴瘤(diffuse large B cell lymphoma,DLBCL)是一组具有高度异质性的疾病,Epstein-Barr病毒(Epstein-Barr virus,EBV)阳性弥漫大B细胞淋巴瘤(EBV-positive diffuse large B-cell lymphoma,EBV+DLBCL)是其中的一种特殊亚型.本研究旨在探讨EBV+DLBCL的临床病理特征及预后.方法:收集2016年1月至2023年10月于烟台毓璜顶医院病理科确诊的27例EBV+DLBCL患者及75例EBV-DLBCL患者,回顾性分析EBV+DLBCL患者的临床资料、病理组织形态、免疫组织化学染色及预后,并对比研究EBV+与EBV-DLBCL患者的细胞表面分化簇(cluster of differentiation,CD)30、程序性死亡-配体1(programmed death-ligand 1,PD-L1)表达情况.结果:EBV+DLBCL占DLBCL患者的2.3％(27/1 168),年龄为65(29～88)岁,男女比例为1.25꞉1.胃是结外发病的好发部位(6/14,42.9％).17例患者Ann-Arbor分期为Ⅲ～Ⅳ期(65.4％,17/26).7例患者死亡,20例生存.Spearman相关性分析显示:EBV+DLBCL患者肿瘤蛋白53(tumor protein 53,P53)与EBV编码RNA(EBV encoded RNA,EBER)和CD30之间均无相关性(均P>0.05).Kaplan-Meier生存分析显示:EBV+DLBCL中P53表达>50％的患者预后更差(χ2=7.374,P<0.01),27例EBV+DLBCL患者与同期获得随访的194例EBV-DLBCL患者整体预后差异无统计学意义(P>0.05);在年龄≥50岁的患者中,EBER阳性细胞占比≥50％的EBV+DLBCL患者预后差于同期EBV-DLBCL患者(P<0.05);EBV+DLBCL患者中CD30阳性率为76.9％,显著高于EBV-DLBCL患者(χ2=31.166,P<0.01);EBV+DLBCL患者CD30阳性表达率中位值显著高于EBV-DLBCL患者(χ2=4.332,P<0.05);Kaplan-Meier生存分析还显示CD30表达对EBV+、EBV-和整体预后的影响差异均无统计学意义(均P>0.05).EBV+DLBCL患者中PD-L1阳性率为50％,PD-L1表达在EBV+与EBV-患者之间差异无统计学意义(P>0.05).PD-L1表达对EBV+DLBCL患者的预后无影响,在EBV-DLBCL患者(χ2=8.418,P<0.01)和DLBCL整体患者(χ2=7.921,P<0.01)中,PD-L1阳性患者预后更差.结论:EBV+DLBCL是一种发病率较低的疾病,老年男性患者多为高侵袭性淋巴瘤,胃是结外好发部位.P53阳性表达>50％的患者预后更差.老年患者EBV+DLBCL的预后差于EBV-DLBCL.EBV+DLBCL患者CD30表达显著高于EBV-DLBCL患者,EBV-DLBCL和DLBCL整体患者中PD-L1阳性者预后较差.
Clinicopathological features and prognosis of 27 patients with EBV-positive diffuse large B-cell lymphoma
Objective:Diffuse large B-cell lymphoma(DLBCL)is a highly heterogeneous group of diseases.Epstein-Barr virus(EBV)-positive diffuse large B-cell lymphoma(EBV+DLBCL)is a special subtype of DLBCL.This study aims to investigate the clinicopathological features and prognosis of EBV+DLBCL.Methods:We retrospectively collected data from 27 EBV+DLBCL patients and 75 EBV-DLBCL patients who were diagnosed at the Department of Pathology,Yantai Yuhuangding Hospital,from January 2016 to October 2023.Clinical data,pathological morphology,immunohistochemistry,and prognosis were analyzed,and the expression of cluster of differentiation(CD)30 and programmed death-ligand 1(PD-L1)between EBV+and EBV-DLBCL patients were compared.Results:EBV+DLBCL accounted for 2.3%of DLBCL cases(27/1 168),with an age of 65(29-88)years and a male-to-female ratio of 1.25꞉1.The stomach was the most common extranodal site(6/14,42.9%).17 patients were in Ann-Arbor stages Ⅲ-Ⅳ(65.4%,17/26).Seven patients died,and 20 survived.Spearman correlation analysis revealed no correlation between tumor protein 53(P53)and Epstein-Barr virus-encoded RNA(EBER)or CD30 in EBV+DLBCL patients.Kaplan-Meier survival analysis showed that patients with P53 expression>50%had a worse prognosis(χ2=7.374,P<0.01).No significant difference in overall prognosis was observed between the 27 EBV+DLBCL patients and 194 contemporaneously followed EBV-DLBCL patients.However,among patients aged≥50 years,those with≥50%EBER-positive cells had a worse prognosis compared to EBV-DLBCL patients(P<0.05).The CD30 positivity rate in EBV+DLBCL patients was 76.9%,significantly higher than that in EBV-DLBCL patients(χ2=31.166,P<0.01).The average CD30 positive expression rate was also significantly higher in EBV+DLBCL patients compared to EBV-DLBCL patients(χ2=4.332,P<0.05).Kaplan-Meier survival analysis showed no significant difference in the impact of CD30 expression on the prognosis of EBV+,EBV-,or overall DLBCL patients.The PD-L1 positivity rate in EBV+DLBCL patients was 50%,with no significant difference between EBV+and EBV-DLBCL patients.PD-L1 expression had no impact on the prognosis of EBV+DLBCL patients,but there were worse prognosis in EBV-patients(χ2=8.418,P<0.01)and overall DLBCL patients(χ2=7.921,P<0.01).Conclusion:EBV+DLBCL is a rare disease,typically affecting elderly males with highly aggressive lymphoma,with the stomach being the most common extranodal site.Patients with P53 expression>50%have a poorer prognosis.The prognosis of elderly patients with EBV+DLBCL is worse than that with EBV-DLBCL.CD30 expression is associated with a poorer prognosis in EBV+DLBCL patients,and PD-L1 positivity is associated with a poorer prognosis in EBV-DLBCL and overall DLBCL patients.
diffuse large B-cell lymphomaEpstein-Barr virusclinicopathological features
万方数据
维普
