C-MYC and BCL2 as prognostic markers in diffuse large B-cell lymphoma: a systematic review and meta-analysis

Objectives: To elucidate the prognostic potential of C-MYC expression in patients with DLBCL. We also further investigated the effects of BCL2 and BCL6 proteins on the prognosis of DLBCL patients. Methods: We conducted a detailed systematic review and meta-analysis using randomized clinical trial (RCT) data. Literature searches were conducted on PubMed, Web of Science and CNKI databases for studies published before January 31, 2008. Hazard ratios (HR) for the overall survival (OS) and the progression-free survival (PFS) were calculated using Revman5.4. Data quality was independently assessed by two investigators. Results: A total of 36 studies with 8533 patients were included. The HR of OS and PFS in DLBCL patients with overexpression of C-MYC protein were 1.47 [95% CI, 1.36 to 1.59] and 1.31 [95% CI, 1.22 to 1.41], respectively. BCL2 overexpression could be associated with poor DLBCL outcome whereas BCL6 overexpression showed non-conclusive results. The HR of OS and PFS of patients with DLBCL co-overexpressed with BCL2 and C-MYC proteins was 1.41 (95% CI, 1.30 to 1.53) and 1.40 (95% CI, 1.34 to 1.56), respectively. Conclusions: Our work further confirmed the possibility of applying C-MYC and BCL2 as biomarkers in the prognosis of DLBCL. More studies would be required to have a more solid conclusion, particularly for BCL6.