Histopathology, cell proliferation indices and clinical outcome in 304 patients with mantle cell lymphoma (MCL): a clinicopathological study from the European MCL Network.
Mantle cell lymphoma (MCL) is a distinct lymphoma subtype with a particularly poor clinical outcome. The clinical relevance of the morphological characteristics of these tumours remains uncertain. The European MCL Network reviewed 304 cases of MCL to determine the prognostic significance of histopathological characteristics. Cytomorphological subtypes, growth pattern and markers of proliferation (mitotic and Ki-67 indices) were analysed. In addition to the known cytological subtypes, classical (87.5%), small cell (3.6%), pleomorphic (5.9%) and blastic (2.6%), we identified new pleomorphic subgroups with mixtures of cells (classical + pleomorphic type; 1.6%) or transitions (classical/pleomorphic type; 1.6%), which, however, did not differ significantly in overall survival time. Exactly 80.5% of cases displayed a diffuse growth pattern, whereas 19.5% of cases had a nodular growth pattern, which was associated with a slightly more favourable prognosis. A high proliferation rate (mitotic or Ki-67 indices) was associated with shorter overall survival. Cut-off levels were defined that allowed three subgroups with different proliferation rates to be discriminated, which showed significantly different clinical outcomes (P < 0.0001). Based on this large clinicopathological study of prospective clinical trials, multivariate analysis confirmed the central prognostic role of cell proliferation and its superiority to all other histomorphological and clinical criteria.
Tiemann
Markus
M
Department of Haematopathology and Lymph Node Registry, University Hospitals of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Schrader
Carsten
C
Klapper
Wolfram
W
Dreyling
Martin H
MH
Campo
Elias
E
Norton
Andrew
A
Berger
Francoise
F
Kluin
Philip
P
Ott
German
G
Pileri
Stephano
S
Pedrinis
Ennio
E
Feller
Alfred C
AC
Merz
Hartmut
H
Janssen
Dirk
D
Hansmann
Martin L
ML
Krieken
Han
H
Möller
Peter
P
Stein
Harald
H
Unterhalt
Michael
M
Hiddemann
Wolfgang
W
Parwaresch
Reza
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis*; D049109:Cell Proliferation; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D019394:Ki-67 Antigen / Q000032:analysis*; D020522:Lymphoma, Mantle-Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008940:Mitotic Index; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen