Blood Res.  2013 Dec;48(4):266-273. 10.5045/br.2013.48.4.266.

Prognostic value of immunohistochemical algorithms in gastrointestinal diffuse large B-cell lymphoma

• Hwang HS
• Yoon DH
• Suh C
• Park CS
• Huh J

• KMID: 2172874
• DOI: http://doi.org/10.5045/br.2013.48.4.266

Abstract

BACKGROUND
Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous clinicopathological entity, and its molecular classification into germinal center B cell-like (GCB) and activated B cell-like (ABC) subtypes using gene expression profile analysis has been shown to have prognostic significance. Recent attempts have been made to find an association between immunohistochemical findings and molecular subgroup, although the clinical utility of immunohistochemical classification remains uncertain.
METHODS
The clinicopathological features and follow-up data of 68 cases of surgically resected gastrointestinal DLBCL were analyzed. Using the immunohistochemical findings on tissue microarray, the cases were categorized into GCB and non-GCB subtypes according to the algorithms proposed by Hans, Muris, Choi, and Tally.
RESULTS
The median patient age was 56 years (range, 26-77 years). Of the 68 cases included, 39.7% (27/68) involved the stomach, and 60.3% (41/68) involved the intestines. The GCB and non-GCB groups sorted according to Hans, Choi, and Tally algorithms, but not the Muris algorithm, were closely concordant (Hans vs. Choi, kappa=0.775, P<0.001; Hans vs. Tally, kappa=0.724, P<0.001; Choi vs. Tally, kappa=0.528, P<0.001). However, there was no prognostic difference between the GCB and non-GCB subtypes, regardless of the algorithm used. On univariate survival analyses, international prognostic index risk group and depth of tumor invasion both had prognostic significance.
CONCLUSION
The Hans, Choi, and Tally algorithms might represent identical DLBCL subgroups, but this grouping did not correlate with prognosis. Further studies may delineate the association between immunohistochemical subgroups and prognosis.

Keyword

Diffuse large B-cell lymphoma; Gastrointestinal tract; Immunohistochemistry; Prognosis

MeSH Terms

B-Lymphocytes*
Classification
Follow-Up Studies
Gastrointestinal Tract
Germinal Center
Humans
Immunohistochemistry
Intestines
Lymphoma, B-Cell*
Prognosis
Stomach
Transcriptome

Figure

• 

  Fig. 1 Examples of partially positive staining for each immunohistochemical marker. (A) CD10 staining showing a positive reaction in a small proportion of the tumor cells (about 20%), which is considered to be a negative result in all 4 algorithms (×100). (B) MUM1 staining exhibiting reactivity in about 40% of tumor cells, which is considered to be positive in the Hans and Tally algorithms but negative in the Choi algorithm (×100). (C) GCET1 positive staining in some tumor cells (about 30%), which is considered to be a negative result in the Choi algorithm (×100). (D) LMO2 positive staining in scattered tumor cells with anaplastic nuclei (about 20%) (×100).

• 

  Fig. 2 Summary of the (A) Hans, (B) Muris, (C) Choi, and (D) Tally algorithms, and criteria for a positive signal for individual immunohistochemical markers (below or to the right of the white-filled box). Note that the positive criterion for MUM1/IRF4 in the Choi algorithm (more than 80%) is different from that of the other algorithms (more than 30%).

• 

  Fig. 3 Kaplan-Meier survival analyses with respect to the (A) IPI risk group, (B) depth of tumor invasion and (C) Lugano stage.

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