Epstein barr virüs pozitif ve negatif pediatrik hodgkin ve nonhodgkin lenfomalarda hücre proliferasyonu ve apoptoz ilişkili faktörlerin prognoz ile ilişkisi

Abstract

Pediatrik HL ve NHL patogenezinde apoptoz, proliferasyon, EBV iliskisi güncelarastırılmaktadır. Antiapoptotik Bcl-2, proapoptotik bax, apoptoz inhibitör protein survivin,ekstrensek apoptoz yolagı reseptörü fas, tümör süpresör p53 apoptoz iliskili faktörlerdir. C-mychücre siklusunun G1-S faz geçisinde etkin bir onkogen, ki-67 G1-S-G2-M fazlarında ekspreseolan proliferasyon belirleyicisidir. Bu çalısmanın amacı pediatrik HL ve NHL'da EBV,proliferasyon, apoptoz ve iliskili faktörlerin patogenez ve prognozdaki rolünü arastırmaktır.EBV-EBER, LMP-1, ki-67, bcl-2, bax, survivin, p53, c-myc, fas, in-situ TUNEL yöntemiile apoptotik indeks(A) 63 HL, 70 NHL'da arastırılmıstır. Bulgularla klinik veriler Ki-kare, MannWhitney U, Pearson korelasyon, Kaplan Meier sagkalım analizleriyle istatistikseldegerlendirilmistir.HL olgularının yas ortalaması 8.46'dır. Otuziki erken, 31 geç evre olguda dört exitus, altırekürrens saptanmıstır. Genel sagkalım %94, olaysız sagkalım %83.6' dır. EBV %82.5, bax%74.6, bcl-2 %47.6, survivin %43, p53 %33.3, fas %54 ve c-myc %25.4 pozitiftir. A ortalama%18,22, proliferasyon indeksi %57,83'dür. EBV ile proliferasyon indeksi pozitif, A ters iliskili;bax, bcl-2, survivin, p53, fas, c-myc iliskisiz bulunmustur. Tüm parametreler sagkalımiliskisizdir.NHL olgularının yas ortalaması 7.16'dır. Erken evre yedi, ileri evre 63 olgunun, onundaexitus, dördünde rekürrens vardır. Genel sagkalım %82, olaysız sagkalım %75'tir. EBV %25.7,bax %40, bcl-2 %50, survivin %42,9, p53 %8,6, fas %18,6, c-myc %45,7 pozitiftir. A ortalama131,29/5000 hücre, PI %55,97'dir. EBV fasla iliskili, bcl-2 ile ters iliskilidir. Diger faktörlerleiliskisizdir. Hiçbir faktör sagkalım belirleyicisi degildir.Sonuçlarımız EBV'nin pediatrik HL patogenezinde proliferatif aktiviteyi tetikleyipapoptozu önleyerek rol oynayabilecegi desteklemektedir, ancak prognoz belirleyici degildir.Pediatrik NHL serimizde bulgular EBV'nin patogenezde öncelikli etkili olmadıgınıdesteklemektedir.

Apoptosis, proliferation and relationship with EBV is a contemporary issue in thepathogenesis of HL and NHL. Antiapoptotic bcl-2, proapoptotic bax, inhibitor of apoptosis proteinsurvivin, extrensec apoptotic pathway receptor fas, tumor supressor gene product p53 are apoptosisrelatedproteins. C-myc is an oncogene that plays a role in cell-cycle G1-S pass. Ki 67 is aproliferation marker expressed in G1, S, G2, M phases of cell-cycle. In this study prognostic orpathogenetic role of EBV, proliferating activity, apoptosis and regulating proteins in pediatric HLand NHL were explored.EBV-EBER, lmp-1, ki-67, Bcl-2, survivin, Bax, fas, c-myc, p53 and AI detected by in-situTUNEL method were explored in.63 HL and 70 NHL cases Statistical evaluation was done by chisquare,Mann Whitney U test, Pearson Correlation and Kaplan Meier survival analysis.The mean age of HL cases was 8.46. Among 32 early and 31 advanced stage cases exitus wasobserved in four and relapse in six cases. Overall survival was 94% and event free survival 83.6%.EBV was positive in 82.5%, bax in 74.6%, bcl-2 in 47.6%, survivin in 43%, p53 in 33.3%, fas in54% and c-myc in 25.4% cases. Mean AI was 18,22%. Mean proliferation index(PI) was 57,83%.EBV was positively related with PI and negatively with AI, not with bax, bcl-2, survivin, p53, fasand c-myc. None of the parameters were related with prognosis.The mean age of NHL cases was 7.16. Among seven early stage and 63 advenced stage casesexitus was observed in 10 cases and relapse in four cases. Overall survival was 82%, while eventfree survival was 75%. EBV was positive in 25.7%, bax in 40%, bcl-2 in 50%, survivin in 42,9%,p53 in 8,6%, fas in 18,6% ve c-myc 45,7%. Mean AI was 131,29/5000 cells, mean PI was 55,97%.EBV was related with fas and negatively related with bcl-2, not ralated by other factors. None of theparameters were related with prognosis.Our results suggest that EBV might play a role in HL pathogenesis by inducing proliferativeactivity and by inhibiting apoptosis but does not predict prognosis. Our results of pediatricNHL series indicate that EBV does not have a primary role in the pathogenesis.