[Effect of P53 Expression on Prognosis of Patients with Double Expressor Lymphoma]

Abstract

Objective: To investigate the effect of P53 expression on prognosis of patients with double expressor lymphoma(DEL) and the interaction between the expression of MYC, BCL2 and P53 in diffuse large B-cell lymphoma(DLBCL).

Methods: Eighty-eight patients with newly diagnosed DLBCL from 1st September 2012 to 31th May 2018 in Shanxi Dayi Hospital affiliated to Shanxi Medical University were selected. The expressions of MYC、BCL2、P53、CD10、BCL6、MUM and Ki-67 were tested by immunohistochemistry method. The overall survival of patients was analyzed by the Kaplan-Meier method and compared by the log-rank test. The prognostic effect of MYC, BCL2 and P53 expression was analyzed by univariate and multivariate analysis.

Results: Compared with patients without P53 expression, the patients with P53 expression had higher LDH level, higher NCCN-IPI scores, lower response to chemotherapy，poorer overall survival(OS) and a higher rate of death(P<0.05). In patients who had diffuse large B-cell lymphoma associated with MYC, BCL2 expression or MYC⁺/BCL2⁺ double expression， compared with the patients whom without P53 expression, P53 expression associated with a significant worse OS (P<0.05). The patients with concurrent MYC and P53 expression had a worse OS, compared with patients with either P53 or MYC expression(P<0.05). In patients with MYC⁺/P53⁺ co-expression, BCL2 expression did not correlate with poorer survival significantly(P>0.05). Among lymphoma patients with MYC⁺/P53⁺, MYC⁺/BCL2⁺ and BCL2⁺/P53⁺ co-expression, the patients with MYC⁺/P53⁺ co-expression had the worse OS (3 year OS rate：31.6%), followed by the subgroup of patients with MYC^-/BCL2⁺/P53⁺(3 year OS rate：46.2%), patients with MYC⁺/BCL2⁺/P53^- expression(3 year OS rate： 636%) showed a longer OS compared with the other two subgroups（P<0.05）. Multivariate analysis demonstrated that P53 expression and NCCN-IPI were independent prognostic factors in this patient cohort.

Conclusion: P53 and MYC expressions have a synergistically negative prognostic effect in DLBCL patients. P53 expression augments the negative prognostic effect of MYC⁺/BCL2⁺ double expression. Patients with MYC⁺/P53⁺ co-expression have a worse prognosis in comparison with the patients with MYC⁺/BCL2⁺ double expression.