摘要
目的·探究甲状腺弥漫性大B细胞淋巴瘤(diffuse large B-cell lymphoma,DLBCL)临床病理特征、基因突变谱及预后相关因素.方法·回顾性分析2003年11月—2021年12月上海交通大学医学院附属瑞金医院收治的66例初次诊断为甲状腺DLBCL患者[原发甲状腺DLBCL 23例(34.8%),继发甲状腺DLBCL 43例(65.2%)]的临床病理资料,并进行生存和预后因素分析.其中40例甲状腺DLBCL患者进行了靶向测序(55个淋巴瘤相关基因)以评估基因突变情况.结果·继发甲状腺DLBCL患者Ann Arbor分期Ⅲ～Ⅳ期(P=0.000)、乳酸脱氢酶(lactate dehydrogenase,LDH)升高(P= 0.043)、结外器官受累数目≥2个(P=0.000)、非生发中心来源(non-GCB)(P=0.030)、MYC和BCL2蛋白双表达(double expression,DE)(P=0.026)、国际预后指数3～5分(P=0.000)的比例高于原发甲状腺DLBCL患者,其接受甲状腺手术切除的比例(P=0.012)低于原发甲状腺DLBCL患者.原发甲状腺DLBCL患者完全缓解(complete response,CR)率高于继发患者(P=0.039).55例患者(83%)接受以利妥昔单克隆抗体联合环磷酰胺、阿霉素、长春新碱及泼尼松(R-CHOP)为基础的一线治疗方案,其中原发甲状腺DLBCL患者预期5年无进展生存(progress free survive,PFS)率95.0%,高于继发患者的49.7%(P=0.010).单因素分析显示:Ann Arbor Ⅲ～Ⅳ期(HR=4.411,95%CI 1.373～14.170)、LDH升高(HR= 5.500,95%CI 1.519～19.911)、non-GCB(HR=5.291,95%CI 1.667～16.788)、DE(HR=6.178,95%CI 1.813～21.058)是甲状腺DLBCL患者PFS的不良预后因素;Ann Arbor Ⅲ～Ⅳ期(HR=7.088,95%CI 0.827～60.717)、LDH升高(HR=6.982,95%CI 0.809～60.266)、DE(HR=18.079,95%CI 1.837～177.923)是总生存(overall survival,OS)时间的不良预后因素.多因素分析显示:Ann Arbor Ⅲ～Ⅳ期(HR=4.693,95%CI 1.218～18.081)和LDH升高(HR=5.058,95%CI 1.166～21.941)是甲状腺DLBCL患者PFS的独立不良预后因素.靶向测序结果显示,TET2(n=14,35%)、KMT2D(n=13,32%)、TP53(n=11,28%)、GNA13(n=10,25%)、KMT2C(n=9,22%)突变频率>20%,且TP53突变是甲状腺DLBCL患者PFS的不良预后因素(P=0.000).结论·原发甲状腺DLBCL生存情况优于继发甲状腺DLBCL.Ann Arbor Ⅲ～Ⅳ期、LDH升高、non-GCB、DE(MYC和BCL2)是影响甲状腺DLBCL患者的不良预后因素.TET2、KMT2D、TP53、GNA13、KMT2C是甲状腺DLBCL中常见的高突变基因,TP53突变的患者预后不佳.
Abstract
Objective·To analyze the clinicopathologic characteristics,gene mutation profile,and prognostic factors of thyroid diffuse large B-cell lymphoma(DLBCL).Methods·From November 2003 to December 2021,a total of 66 patients with thyroid DLBCL[23 cases(34.8%)with primary thyroid DLBCL,and 43 cases(65.2%)with secondary thyroid DLBCL]admitted to Ruijin Hospital,Shanghai Jiao Tong University School of Medicine were retrospectively analyzed for their clinicopathological data,survival and prognostic factors.Gene mutation profiles were evaluated by targeted sequencing(55 lymphoma-related genes)in 40 patients.Results·Compared to primary thyroid DLBCL,secondary thyroid DLBCL had advanced ratio of Ann Arbor stage Ⅲ‒Ⅳ(P=0.000),elevated serum lactate dehydrogenase(LDH)(P=0.043),number of affected extranodal involvement≥2(P=0.000),non-germinal center B cell(non-GCB)(P=0.030),BCL-2/MYC double expression(DE)(P=0.026),and international prognostic index(IPI)3‒5-scores(P=0.000).The proportion of patients who underwent thyroid surgery(P=0.012)was lower than that of patients with primary thyroid DLBCL.The complete remission(CR)rate in primary thyroid DLBCL patients was higher than that in secondary thyroid DLBCL patients(P=0.039).Fifty-five patients(83%)received rituximab combined with cyclophosphamide,doxorubicin,vincristine,and prednisone(R-CHOP)-based first-line regimen.The estimated 5-year progression free survival(PFS)rate of primary thyroid DLBCL patients was 95.0%,higher than the 49.7%of the secondary patients(P=0.010).Univariate analysis showed that Ann Arbor Ⅲ‒Ⅳ(HR=4.411,95%CI 1.373‒14.170),elevated LDH(HR=5.500,95%CI 1.519‒19.911),non-GCB(HR= 5.291,95%CI 1.667‒16.788),and DE(HR=6.178,95%CI 1.813‒21.058)were adverse prognostic factors of PFS in patients with thyroid DLBCL.Ann Arbor Ⅲ‒Ⅳ(HR=7.088,95%CI 0.827‒60.717),elevated LDH(HR=6.982,95%CI 0.809‒60.266),and DE(HR=18.079,95%CI 1.837‒177.923)were adverse prognostic factors of overall survival(OS).Multivariate analysis showed that Ann Arbor Ⅲ‒Ⅳ(HR=4.693,95%CI 1.218‒18.081)and elevated LDH(HR=5.058,95%CI 1.166‒21.941)were independent adverse prognostic factors of PFS in patients with thyroid DLBCL.Targeted sequencing data showed mutation frequency>20%in TET2(n=14,35%),KMT2D(n=13,32%),TP53(n=11,28%),GNA13(n=10,25%),KMT2C(n=9,22%),and TP53 were adverse prognostic factors of PFS in patients with thyroid DLBCL(P=0.000).Conclusion·Patients with primary thyroid DLBCL have better PFS and OS than those with secondary thyroid DLBCL.Ann Arbor Ⅲ‒Ⅳ,elevated LDH,non-GCB,and DE(MYC and BCL2)are adverse prognostic factors in thyroid DLBCL.TET2,KMT2D,TP53,GNA13,and KMT2C are commonly highly mutated genes in thyroid DLBCL,and the prognosis of patients with TP53 mutations is poor.
基金项目
国家自然科学基金(82130004)
国家自然科学基金(81830007)
国家自然科学基金(81670176)
国家自然科学基金(82070204)
上海交通大学医学院"双百人"项目(20230013)
维普
万方数据