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Identification of prognostic factors in patients with diffuse large B-cell lymphoma

Fang Peng1, Liang Guo1, Wei-Kai Yao1

  • 1Department of Pathology, The First Hospital of Jilin University, Changchun, China.

Indian Journal of Pathology & Microbiology
|February 15, 2017
PubMed

Insights

Prognostic factors like ECOG performance score and specific protein expressions (Bcl-2, CD10, Bcl-6) predict outcomes in diffuse large B-cell lymphoma (DLBCL). These factors remain significant even in cases with conflicting classifications.

Area of Science:

  • Hematology
  • Oncology
  • Immunohistochemistry

Background:

  • Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease.
  • Prognostic classification algorithms like Hans' and Choi's aid in predicting patient outcomes.
  • Conflicting classifications between algorithms can complicate prognostic assessment.

Purpose of the Study:

  • To identify prognostic factors for de novo diffuse large B-cell lymphoma (DLBCL) patients.
  • To evaluate prognostic factors in DLBCL cases with conflicting classifications by Hans' and Choi's algorithms.
  • To assess the concordance and clinical relevance of two major DLBCL classification algorithms.

Main Methods:

  • Retrospective review of clinical and pathological data from 154 de novo DLBCL patients.
  • Classification of DLBCL subtypes using Hans' and Choi's algorithms with immunohistochemical markers.
  • Statistical analysis of clinicopathological factors, International Prognostic Index, and 5-year survival rates.

Main Results:

  • Eastern Cooperative Oncology Group (ECOG) performance score 2-5, positive Bcl-2, negative CD10, and negative Bcl-6 expression correlated with worse prognosis.
  • Hans' and Choi's algorithms showed good concordance (83% agreement, Kappa = 0.660).
  • Germinal center B-cell-like (GCB) subtype had significantly better 5-year overall survival than non-GCB subtypes by both classifications.
  • In the 25 cases with conflicting classifications, the same adverse prognostic factors (ECOG 2-5, positive Bcl-2, negative CD10, negative Bcl-6) were identified.

Conclusions:

  • ECOG performance score 2-5, positive Bcl-2, negative CD10, and negative Bcl-6 expression are independent markers for poor prognosis in DLBCL.
  • These prognostic markers retain significance even in DLBCL cases with conflicting classifications between Hans' and Choi's algorithms.
  • The study highlights key immunohistochemical markers for predicting DLBCL patient outcomes, irrespective of classification algorithm discrepancies.

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