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[Immunohistochemical classification and prognosis of diffuse large B-cell lymphoma in China]
Yan Chen1, Li Xiao, Xiongzeng Zhu
1Department of Pathology, Shanghai Huadong Hospital, Fudan University, Shanghai 200040, China.
Insights
Immunohistochemical algorithms failed to effectively classify Chinese diffuse large B-cell lymphoma (DLBCL) into prognostic subtypes. Primary gastric DLBCL showed distinct immunophenotype and better outcomes compared to other sites.
Area of Science:
- Hematology
- Oncology
- Immunohistochemistry
Context:
- Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous lymphoid malignancy.
- Accurate subtyping of DLBCL is crucial for predicting patient prognosis and guiding treatment decisions.
- Existing immunohistochemical algorithms, including Hans, Choi, and Tally, aim to classify DLBCL into germinal center B-cell-like (GCB) and activated B-cell-like (ABC) subtypes.
Purpose:
- To evaluate the efficacy of Hans, Choi, and Tally immunohistochemical algorithms in classifying Chinese DLBCL cases.
- To compare the clinical features and survival outcomes of GCB and non-GCB/ABC subtypes.
- To identify prognostic factors for overall survival in DLBCL patients.
Summary:
- A total of 148 DLBCL cases were analyzed using three distinct immunohistochemical algorithms.
- The study found that these algorithms did not effectively differentiate prognostic subtypes in the Chinese DLBCL cohort.
- Primary gastric DLBCL exhibited a different immunophenotype and a trend towards better survival compared to DLBCL in other locations.
- Patient age and tumor stage were identified as significant adverse predictors of overall survival.
Impact:
- The findings suggest limitations of current immunohistochemical algorithms for classifying Chinese DLBCL, necessitating further research into alternative or refined classification methods.
- Highlights the unique characteristics of primary gastric DLBCL, potentially influencing diagnostic and therapeutic strategies.
- Provides valuable insights into prognostic factors beyond immunophenotype, aiding in risk stratification for DLBCL patients.
Objective:
To study the immunohistochemical classification and prognosis of diffuse large B-cell lymphoma (DLBCL).
Methods:
A total of 148 cases of DLBCL were classified into germinal center B-cell-like (GCB) and non-GCB/activated B-cell-like (ABC) subtypes by Hans, Choi and Tally immunohistochemical stain algorithms. The clinical features and survival data of GCB and non-GCB/ABC subtypes were compared. Multivariate analysis about clinical features and results of immunohistochemical stain algorithms was carried out by using Cox regression, with overall survival as the outcome.
Results:
The prevalence of GCB subtype was significantly lower than that of non-GCB/ABC subtype, as classified by whichever algorithms in the 148 DLBCL cases studied. The prevalence of GCB subtype by Tally algorithm was lowest. The prevalence of GCB subtype (19 cases, 16.7%) was also significantly lower than non-GCB/ABC subtype (95 cases, 83.3%; P = 0.000 1) in the 114 (77.0%) concordant cases by the three algorithms. There was no difference between GCB and non-GCB/ABC subtypes by the three algorithms in five-year overall survival rate and survival curve of the 80 DLBCL patients with follow-up data available (P > 0.05). Primary gastric DLBCL tended to show a higher prevalence of GCB subtype, a better five-year overall survival rate and survival curve than the other groups. Multivariate analysis showed that patient age (HR = 1.036, P = 0.001) and tumor stage (HR = 1.997, P = 0) were also significantly adverse predictors of overall survival.
Conclusion:
The Hans, Choi and Tally immunohistochemical stain algorithms cannot effectively classify Chinese DLBCL into different prognostic subtypes. Primary gastric DLBCL has different immunophenotype and outcome, as compared with DLCBL in other sites.
