标题：Caspase-9和CMYC在弥漫性大B细胞淋巴瘤中的表达及与患者病理特征和预后的关系

      作者：卜晓红 1，王富强 2，戴静 3，王彩玲 4    卜晓红 1，王富强 2，戴静 3，王彩玲 41.周口市中心医院病理科，河南 周口 466000；2.安阳市肿瘤医院病理科，河南 安阳 455001；3.周口市中心医院血液科，河南 周口 466000；4.安阳市肿瘤医院肿瘤内科，河南 安阳 455001

      卷次： 2024年35卷4期

      【摘要】 目的 探讨半胱氨酸蛋白酶-9 (Caspase-9)和细胞性骨髓细胞瘤病病毒癌基因(CMYC)在弥漫性大B细胞淋巴瘤(DLBCL)组织中的表达及其与患者病理特征和预后的关系。方法 选取2017年2月至2020年2月周口市中心医院收治的60例DLBCL患者纳入研究，比较DLBCL肿瘤组织及病灶旁正常组织的Caspase-9、CMYC表达水平，分析Caspase-9、CMYC表达与临床病理特征的关系，比较预后良好和预后不良患者的临床病理特征、Caspase-9、CMYC表达水平，采用二元Logistic回归分析DLBCL患者预后不良的影响因素。结果 DLBCL患者肿瘤组织中Caspase-9阳性率为43.33%，明显低于正常组织的80.56%，CMYC阳性率为36.67%，明显高于正常组织的13.88%，差异均有统计学意义(P<0.05)；Ann Arbor分期Ⅰ~Ⅱ期、国际预后指数(IPI)评分0~2分患者DLBCL肿瘤组织Caspase-9阳性率明显高于Ⅲ~Ⅳ期和3~4分患者，CMYC阳性率低于Ⅲ~Ⅳ期、3~4分患者，差异均有统计学意义(P<0.05)；预后不良患者 Ann Arbor分期中Ⅲ~Ⅳ期占比、IPI评分中 3~4分占比、CMYC阳性表达占比分别为73.08%、65.38%、69.23%，均高于预后良好组的35.29%、32.35%、11.76%，Caspase-9阳性表达占比为23.08%，低于预后良好组的 58.82%，差异均有统计学意义(P<0.05)；Ann Arbor分期、IPI评分、Caspase-9、CMYC均为影响DLBCL患者预后不良的独立影响因素(P<0.05)，其中Ann Arbor分期Ⅲ~Ⅳ期预后不良风险是Ⅰ~Ⅱ期的9.008倍；IPI评分3~4分预后不良风险是0~2分的10.298倍；Caspase-9表达阳性预后不良风险是阴性的0.622倍；CMYC表达阳性预后不良风险是阴性的19.922倍。结论 Caspase-9、CMYC异常表达参与DLBCL的进展，与肿瘤恶性程度有关，且Caspase-9、CMYC异常表达是DLBCL预后不良的独立影响因素，对DLBCL预后具有一定的预测价值，可作为预测DLBCL患者预后的参考指标。
      【关键词】 弥漫性大B细胞淋巴瘤；半胱氨酸蛋白酶-9；细胞性骨髓细胞瘤病病毒癌基因；病理特征；预后
      【中图分类号】 R733.4 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0457—05

Expression of Caspase-9 and CMYC in diffuse large B-cell lymphoma and their relationship with pathologicalcharacteristics and prognosis.
BU Xiao-hong 1, WANG Fu-qiang 2, DAI Jing 3, WANG Cai-ling 4. 1. Department ofPathology, Zhoukou Central Hospital, Zhoukou 466000, Henan, CHINA; 2. Department of Pathology, Anyang CancerHospital, Anyang 455001, Henan, CHINA; 3. Department of Hematology, Zhoukou Central Hospital, Zhoukou 466000,Henan, CHINA; 4. Department of Oncology, Anyang Cancer Hospital, Anyang 455001, Henan, CHINA
【Abstract】 Objective To investigate the expression of matrix metallopmteinase-9 (Caspase-9) and cellula-my-elocytomatosis viral oncogene (CMYC) expression in diffuse large B-cell lymphoma (DLBCL), and their relationshipwith pathological characteristics and prognosis. Methods Sixty DLBCL patients admitted to Zhoukou Central Hospitalfrom February 2017 to February 2020 were selected. The expression of Caspase-9 and CMYC were compared betweenDLBCL tumor tissues and normal tissues. The relationship of Caspase-9 and CMYC expression with clinicopathologicalcharacteristics was analyzed. The clinicopathological features, Caspase-9, and CMYC expression levels of patients withgood prognosis and poor prognosis were compared, and the influencing factors of poor prognosis in DLBCL patientswere analyzed by binary Logistic regression. Results The positive rate of Caspase-9 in tumor tissues of DLBCL pa-tients was 43.33%, which was significantly lower than 80.56% in normal tissues; the positive rate of CMYC was 36.67%in tumor tissues of DLBCL patients, which was significantly higher than 13.88% in normal tissues; the differences werestatistically significant (P<0.05). The positive rate of Caspase-9 in Ann Arbor stageⅠtoⅡand international prognosticindex (IPI) score 0 to 2 of DLBCL tumor tissues were significantly higher than those in DLBCL patients with Ann ArborstageⅢ toⅣ and IPI score 3 to 4; the positive rate of CMYC in Ann Arbor stageⅠ toⅡand IPI score 0 to 2 of DLBCLtumor tissues were significantly lower than those in DLBCL patients with Ann Arbor stageⅢ toⅣ and IPI score 3 to 4;the differences were statistically significant (P<0.05). The proportion of Ann Arbor stage Ⅲ - Ⅳ, IPI score 3 -4 andCMYC positive expression in patients with poor prognosis were 73.08%, 65.38%, and 69.23%, respectively, which weresignificantly higher than 35.29%, 32.35%, and 11.76% in patients with good prognosis; the proportion of Caspase-9 posi-tive expression was 23.08%, which was significantly lower than 58.82% in patients with good prognosis; the differenceswere statistically significant (P<0.05). Ann Arbor stage, IPI score, Caspase-9, and CMYC were all independent factorsaffecting the poor prognosis of DLBCL patients (P<0.05); the risk of poor prognosis in Ann Arbor stage Ⅲ-Ⅳ was9.008 times as much as that in stageⅠ-Ⅱ; the risk of poor prognosis with IPI score of 3 to 4 was 10.298 times as muchas that with IPI score of 0-2; the risk of poor prognosis with positive Caspase-9 expression was 0.622 times as much asthat with negative Caspase-9 expression; the risk of adverse prognosis with positive CMYC expression was 19.922times as much as that with negative CMYC expression. Conclusion Abnormal expression of Caspase-9 and CMYC isinvolved in the occurrence and development of DLBCL, which is related to the degree of malignancy of the tumor. Ab-normal expression of Caspase-9 and CMYC are independent influencing factors of poor prognosis of DLBCL and havecertain predictive value for the prognosis of DLBCL, which can be used as reference indicators to predict the prognosisof DLBCL patients.
      【Key words】 Diffuse large B-cell lymphoma; Matrix metallopmteinase-9; Cellula-myelocytomatosis viral onco-gene; Pathological characteristics; Prognosis