Author/Authors :
SALLAM, YASSER A. Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , NASSAR, HANAN R. Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , EL-SHERBINY, MAMDOUH Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , EL-SHERBINY, MAMDOUH Beni Suef University, Egypt , ZEN EL-DIN, AHMED A. Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , GABER, AYMAN A. Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , HELAL, AMANY Cairo Univnsity - National Cancer Institute - Department of Medical Oncology, Egypt , THARWAT, WAEL Cairo Univnsity - National Cancer Institute - Department of Pathology, Egypt
Abstract :
Purpose: The aim of this study was to find the impact of the various prognostic factors, upon the survival of cases of diffuse large B-cell lymphoma with validation of IPI in this group of patients. Along with study of the prognostic signif-icance of two molecular pathological markers (ki67) and (p53) as well as the prognostic or predictive benefit of adding these markers to IPI.Patients and Methods: This comparative retrospective study included 91 patients, who presented to the National Cancer Institute, Cairo University from year 1998 to year 2005, with histologically proven aggressive diffuse large B- cell lymphoma, whose clinical follow-up exceeded one year. Patients were separated into two groups, forty-four patients were in remission and under follow-up and forty seven patients had a relapse. All the patients were initially treated with first line CHOP combination chemotherapy. Staging of the disease included a complete physical examination with assessment of the patients general status, computed tomography (CT) scans of the chest and abdomen, bone marrow aspiration, complete blood count, ESR, liver, kidney function test, lactate dehydrogenase (LDH) determination and serum uric acid were done before the start of treatment. In addition, the factors included in the International Prognostic Index were studied in those patients, these were age ( 60 years versus 60), LDH (normal versus high), performance status (0 or I versus II), stage (I, II, versus III, IV) and extranodal disease (0 or I versus 11). The response to therapy was evaluated when patients had completed chemotherapy, then every 3 months for 24 months and every 6 months thereafter.Results: The clinical features of 91 patients included in the study were matched for age and sex. Twenty patients (22%) presented with stage 1, twenty-one patients (23%) presented with stage II, thirty-nine patients (43%) presented with stage III and eleven patients (12%) presented with stage IV. The median follow-up time was 24 months (range 3-84), and median survival time was 32 months. The one-year survival rate was 81%, the two years survival rate was 58% and five- year survival rate was 30% for whole group. While 5-year survival rate was 52% for group who achieved a solid complete remission, the 3-year survival rate for relapsing group was 22% with p value 0.001. In our study we found that 5-year survival was statistically significant for female gender. The 5-year survival rates were 39% and 21% for females and males respectively (p value 0.01).The 5-year overall survival rates were 39%, 34% and 15% for patients who were categorised as having no IPI risk factor, 1-2 risk factors and more than 2 risk factors respectively (p value 0.03).Tumour stage correlated significantly with overall survival time (p 0.007). The 5-year survival rate for tumour stage decrease from 40% for stage I, II to 21% for stage III, IV. Performance status correlated significantly with overall survival rate. The 5-year survival rates were 36% and 19% for PS I and II respectively (p value 0.008). Our study noticed that overall survival was slightly better for patients with extranodal disease (O.S was 38%) compared to 25% for nodal only disease (p value 0.4).P53 and ki67 gene expression could be evaluated only in 52 patients out of 91 patients included in this study, the overall survival rates of patients according to ki67 status were 10% for positive cases and 30% for negative cases (p value 0.07) and the overall survival rates of patients according to P53 status were 10% for positive cases and 38% for negative cases (p value 0.1).Conclusion: In this study the overall survival rates were significantly correlated with IPI. Also, this study demonstrated that patients who had extranodal presentation experienced a better survival rate, because most of these cases were localized stage IE. Among the immunohistochemical parameters inves-tigated ki67 reached statistical significance in our study. P53 expression failed to show prognostic relevance in our series.
