Abstract
Background
The analysis of prognostic factors in Japanese cases of cutaneous T-cell lymphoma
(CTCL) is scarce. Clusterin is a ubiquitous 80 kDa heterodimeric glycoprotein expressed on tumor cells of systemic and primary cutaneous
anaplastic large cell lymphoma. The expression of clusterin in mycosis fungoides (MF)
and Sézary syndrome (SS) has only been sporadically reported in a small number of
cases.
Objective
To determine the long-term prognosis of Japanese patients with MF and SS, to identify
clinical and pathological factors predictive of survival, and to evaluate the prognostic
significance of the International Society for Cutaneous Lymphomas (ISCL) revised staging
system (2007).
Methods
We performed a retrospective cohort study of 105 Japanese patients with MF and SS
managed at the Department of Dermatology Asahikawa Medical University from 1976 to
2011. Formalin-fixed, paraffin-embedded sections of MF and SS were immunostained for
clusterin, CD30, and Ki-67.
Results
No statistically significant difference in survival was found between stages IA–IIA
and IIIA patients. The significant prognostic factors in the univariate analysis were
higher age, TNMB classification, clinical staging, performance status, increased serum
LDH level, dermal Ki-67-positive cells, and clusterin expression. In the multivariate
analysis, T classification, extracutaneous disease, increased serum LDH level, clusterin
expression, and performance status were the significant independent prognostic factors.
Conclusion
Japanese stage IIIA MF/SS patients contain a subpopulation with a favorable prognosis.
The most significant prognostic factor for survival of MF and SS was the presence
of extracutaneous disease. Clusterin expression was shown to be a novel unfavorable
prognostic factor.
Abbreviations:
DSS (disease specific survival), NR (not reached), OS (overall survival)Keywords
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References
- Cutaneous T-cell lymphomas: the Sézary syndrome, mycosis fungoides, and related disorders.Ann Intern Med. 1975; 83: 534-552
- WHO-EORTC classification for cutaneous lymphomas.Blood. 2005; 105: 3768-3785
- Prognostic variables in mycosis fungoides.Cancer. 1981; 47: 2671-2677
- Clinical staging for cutaneous T-cell lymphoma.Ann Intern Med. 1984; 100: 187-192
- Histologic assessment of lymph nodes in mycosis fungoides/Sézary syndrome (cutaneous T-cell lymphoma): clinical correlations and prognostic import of a new classification system.Hum Pathol. 1985; 16: 1098-1109
- Evaluation of circulating malignant cells provides prognostic information in cutaneous T cell lymphoma.Blood. 1987; 69: 841-849
- Histopathologic staging at initial diagnosis of mycosis fungoides and the Sézary syndrome. Definition of three distinctive prognostic groups.Ann Intern Med. 1988; 109: 372-382
- Extracutaneous mycosis fungoides.Cancer. 1987; 60: 397-402
- Prognostic clinicopathologic factors in cutaneous T-cell lymphoma.Arch Dermatol. 1991; 127: 1511-1516
- Prognostic factors in erythrodermic mycosis fungoides and the Sézary syndrome.Arch Dermatol. 1995; 131: 1003-1008
- Long-term outcome of 525 patients with mycosis fungoides and Sézary syndrome: clinical prognostic factors and risk for disease progression.Arch Dermatol. 2003; 139: 857-866
- CD8-positive tumor-infiltrating lymphocytes influence the long-term survival of patients with mycosis fungoides.J Am Acad Dermatol. 1995; 32: 448-453
- Increased serum concentration of the soluble interleukin-2 receptor in cutaneous T-cell lymphoma: clinical and prognostic implications.Arch Dermatol. 1996; 132: 42-47
- Prognostic factors and evaluation of mycosis fungoides and Sézary syndrome.J Am Acad Dermatol. 1997; 37: 58-67
- The prognostic significance of delayed hypersensitivity to dinitrochlorobenzene and mechlorethamine hydrochloride in cutaneous T cell lymphoma.J Invest Dermatol. 1998; 110: 946-950
- Sézary cell counts in erythrodermic cutaneous T-cell lymphoma: implications for prognosis and staging.Leuk Lymphoma. 2006; 47: 1841-1856
- Prognostic factor analysis in mycosis fungoides/Sézary syndrome.J Am Acad Dermatol. 1999; 40: 914-924
- Prognosis in cutaneous T-cell lymphoma by skin stage: long-term survival in 489 patients.J Am Acad Dermatol. 1999; 40: 418-425
- The changing survival of patients with mycosis fungoides: a population-based assessment of trends in the United States.Cancer. 1999; 85: 208-212
- Mycosis fungoides: disease evolution and prognosis of 309 Dutch patients.Arch Dermatol. 2000; 136: 504-510
- Transformation of mycosis fungoides: clinicopathological and prognostic features of 45 cases. French Study Group of Cutaneous Lymphomas.Blood. 2000; 95: 2212-2218
- Detection of a peripheral blood T cell clone is an independent prognostic marker in mycosis fungoides.J Invest Dermatol. 2000; 114: 117-121
- Molecular staging of lymph nodes from 60 patients with mycosis fungoides and Sézary syndrome: correlation with histopathology and outcome suggests prognostic relevance in mycosis fungoides.Br J Dermatol. 2006; 155: 756-762
- Prognostic significance of tumor burden in the blood of patients with erythrodermic primary cutaneous T-cell lymphoma.Blood. 2001; 97: 624-630
- Prognostic factors in Sézary syndrome: a study of 28 patients.Br J Dermatol. 2003; 149: 1152-1158
- Prognostic factors and prediction of prognosis by the CTCL Severity Index in mycosis fungoides and Sézary syndrome.Br J Dermatol. 2005; 153: 118-124
- Analysis of T-cell receptor gene rearrangement for predicting clinical outcome in patients with cutaneous T-cell lymphoma: a comparison of Southern blot and polymerase chain reaction methods.Arch Dermatol. 2005; 141: 1107-1113
- Circulating CD8+ lymphocytes, white blood cells, and survival in patients with mycosis fungoides.Br J Dermatol. 2005; 153: 324-330
- Survival of mycosis fungoides in patients in the Southeast of England.Dermatology. 2005; 211: 325-329
- Overall survival in erythrodermic cutaneous T-cell lymphoma: an analysis of prognostic factors in a cohort of patients with erythrodermic cutaneous T-cell lymphoma.Int J Dermatol. 2009; 48: 243-252
- Report of the committee on staging and classification of cutaneous T-cell lymphomas.Cancer Treat Rep. 1979; 63: 725-728
- Prognosis of 100 Japanese patients with mycosis fungoides and Sézary syndrome.J Dermatol Sci. 2010; 57: 37-43
- Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal.J Clin Oncol. 2010; 28: 4730-4739
- Time course, clinical pathways, and long-term hazards risk trends of disease progression in patients with classic mycosis fungoides: a multicenter, retrospective follow-up study from the Italian Group of Cutaneous Lymphomas.Cancer. 2012; 118: 5830-5839
- Long-term outcomes of 1263 patients with mycosis fungoides and Sézary syndrome from 1982 to 2009.Clin Cancer Res. 2012; 18: 5051-5060
- Revisions to the staging and classification of mycosis fungoides and Sézary syndrome: a proposal of the International Society for Cutaneous Lymphomas (ISCL) and the cutaneous lymphoma task force of the European Organization of Research and Treatment of Cancer (EORTC).Blood. 2007; 110: 1713-1722
- Clinical end points and response criteria in mycosis fungoides and Sézary syndrome: a consensus statement of the International Society for Cutaneous Lymphomas, the United States Cutaneous Lymphoma Consortium, and the Cutaneous Lymphoma Task Force of the European Organisation for Research and Treatment of Cancer.J Clin Oncol. 2011; 29: 2598-2607
- Long-term outcomes of patients with advanced-stage cutaneous T-cell lymphoma and large cell transformation.Blood. 2008; 112: 3082-3087
- Transformed mycosis fungoides: clinicopathological features and outcome.Br J Dermatol. 2007; 157: 284-289
- Transformation of mycosis fungoides/Sezary syndrome: clinical characteristics and prognosis.Blood. 1998; 92: 1150-1159
- Clinical features associated with transformation of cerebriform T-cell lymphoma to a large cell process.Hematol Oncol. 1990; 8: 215-227
- Transformation of cutaneous T cell lymphoma to large cell lymphoma: a clinicopathologic and immunologic study.Am J Pathol. 1988; 132: 265-277
- Indolent lymphoplasmacytic and marginal zone B-cell lymphomas: absence of both IRF4 and Ki67 expression identifies a better prognosis subgroup.Haematologica. 2005; 90: 200-206
- Expression of proliferation markers and cell cycle regulators in T cell lymphoproliferative skin disorders.J Dermatol Sci. 2008; 49: 125-132
- The gene for SP-40, 40, human homolog of rat sulfated glycoprotein 2, rat clusterin, and rat testosterone-repressed prostate message 2, maps to chromosome 8.Genomics. 1991; 10: 151-156
- Assignment of a human serum glycoprotein SP-40,40 gene (CLI) to chromosome 8.Cytogenet Cell Genet. 1991; 57: 193-195
- Detection of differentially expressed genes in lymphomas using cDNA arrays: identification of clusterin as a new diagnostic marker for anaplastic large-cell lymphomas.Blood. 2000; 96: 398-404
- Clusterin expression in malignant lymphomas: a survey of 266 cases.Mod Pathol. 2002; 15: 1221-1226
- Clusterin is widely expressed in systemic anaplastic large cell lymphoma but fails to differentiate primary from secondary cutaneous anaplastic large cell lymphoma.Am J Clin Pathol. 2002; 118: 773-779
- a marker for anaplastic large cell lymphoma immunohistochemical profile in hematopoietic and nonhematopoietic malignant neoplasms.Am J Clin Pathol. 2004; 121: 709-717
- Clusterin expression in cutaneous CD30-positive lymphoproliferative disorders and their histologic stimulants.J Cutan Pathol. 2009; 36: 302-307
- Defining early mycosis fungoides.J Am Acad Dermatol. 2005; 53: 1053-1063
- Toxicity and response criteria of the Eastern Cooperative Oncology Group.Am J Clin Oncol. 1982; 5: 649-655
- Update on erythrodermic cutaneous T-cell lymphoma: report of the International Society for Cutaneous Lymphomas.J Am Acad Dermatol. 2002; 46: 95-106
- Poor prognosis in non-Caucasian patients with early-onset mycosis fungoides.J Am Acad Dermatol. 2009; 60: 231-235
- Tumor burden index as a prognostic tool for cutaneous T-cell lymphoma: a new concept.Arch Dermatol. 1999; 135: 1204-1208
- Clinical characteristics and long-term outcome of patients with generalized patch and/or plaque (T2) mycosis fungoides.Arch Dermatol. 1999; 135: 26-32
- Sézary syndrome and related variants of classic cutaneous T-cell lymphoma: a descriptive and prognostic clinicopathologic study of 29 cases.Leuk Lymphoma. 2003; 44: 59-69
- Prognostic factors in Sézary syndrome: a multivariate analysis of clinical, haematological and immunological features.Ann Oncol. 1998; 9: 857-863
- Clinical stage IA (limited patch and plaque) mycosis fungoides: a long-term outcome analysis.Arch Dermatol. 1996; 132: 1309-1313
- Clinical characteristics and outcome of patients with extracutaneous mycosis fungoides.J Clin Oncol. 2001; 19: 779-784
- Prognostic factors in transformed mycosis fungoides: a retrospective analysis of 100 cases.Blood. 2012; 119: 1643-1649
- CD30 expression and proliferative fraction in nontransformed mycosis fungoides.Am J Surg Pathol. 2009; 33: 1860-1868
- Ki-67 immunostaining of normal human epidermis: comparison with 3H-thymidine labelling and PCNA immunostaining.Dermatology. 1998; 197: 123-126
- Clusterin has chaperone-like activity similar to that of small heat shock proteins.J Biol Chem. 1999; 274: 6875-6881
- Clusterin gene expression mediates resistance to apoptotic cell death induced by heat shock and oxidative stress.J Invest Dermatol. 1999; 112: 290-296
Article info
Publication history
Published online: May 23, 2013
Accepted:
April 20,
2013
Received in revised form:
April 10,
2013
Received:
November 16,
2012
Identification
Copyright
© 2013 Japanese Society for Investigative Dermatology. Published by Elsevier Inc. All rights reserved.
