{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T18:21:32Z","timestamp":1790706092529,"version":"4.1.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T00:00:00Z","timestamp":1721606400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010731","name":"Faculty of Medicine, Chiang Mai University","doi-asserted-by":"publisher","award":["ANA-2563-07765, No. 160\/2564"],"award-info":[{"award-number":["ANA-2563-07765, No. 160\/2564"]}],"id":[{"id":"10.13039\/501100010731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Diffuse large B-cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin lymphoma (NHL) that accounts for approximately 25\u201340% of all NHL cases. The objective of this study was to investigate the protein expression, clinical impact, and prognostic role of MYC, BCL2, and Ki-67 in Thai DLBCL patients. A retrospective analysis was conducted on 100 DLBCL patients diagnosed between January 2018 and December 2019. Immunohistochemistry was used to assess the expression of MYC, BCL2, and Ki-67. The study revealed a significant association between extranodal involvement and positive cases of MYC and BCL2. MYC expressions were associated with Ki-67 expression, while BCL2 positivity was associated with the non-germinal center B-cell (non-GCB) subtype. However, there were no significant differences in the three-year overall survival (OS) and three-year progression-free survival (PFS) rates when using cut-off points of \u2265 40% for MYC, \u2265 50% for BCL2, and \u2265 70% for Ki-67. Notably, DLBCL cases with co-expression of MYC and BCL2 exhibited significantly inferior three-year OS compared to other cases (0% vs. 53%; p = 0.020). Multivariate analysis identified age \u2265 60 years and Eastern Cooperative Oncology Group (ECOG) performance status as independent prognostic factors. In conclusion, MYC, BCL2, and Ki-67 expression can serve as prognostic biomarkers; however, their prognostic value may vary based on the specific cut-off values used. Therefore, determining the appropriate threshold for each biomarker based on individual laboratory analyses and clinical outcomes is crucial.<\/jats:p>","DOI":"10.1371\/journal.pone.0307253","type":"journal-article","created":{"date-parts":[[2024,7,22]],"date-time":"2024-07-22T13:27:34Z","timestamp":1721654854000},"page":"e0307253","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Immunohistochemistry-based investigation of MYC, BCL2, and Ki-67 protein expression and their clinical impact in diffuse large B-cell lymphoma in upper Northern Thailand"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-8633-9798","authenticated-orcid":true,"given":"Phuttirak","family":"Yimpak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanokkan","family":"Bumroongkit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2381-9292","authenticated-orcid":true,"given":"Adisak","family":"Tantiworawit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2731-4889","authenticated-orcid":true,"given":"Thanawat","family":"Rattanathammethee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirinda","family":"Aungsuchawan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5968-218X","authenticated-orcid":true,"given":"Teerada","family":"Daroontum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,7,22]]},"reference":[{"issue":"3","key":"pone.0307253.ref001","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1097\/PPO.0000000000000450","article-title":"Molecular Classification and Treatment of Diffuse Large B-Cell Lymphoma and Primary Mediastinal B-Cell Lymphoma","volume":"26","author":"M Roschewski","year":"2020","journal-title":"Cancer J"},{"issue":"6","key":"pone.0307253.ref002","doi-asserted-by":"crossref","first-page":"e98169","DOI":"10.1371\/journal.pone.0098169","article-title":"Immunohistochemical and molecular characteristics with prognostic significance in diffuse large B-cell lymphoma","volume":"9","author":"C Bellas","year":"2014","journal-title":"PloS One"},{"issue":"1","key":"pone.0307253.ref003","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1182\/blood-2003-05-1545","article-title":"Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray","volume":"103","author":"CP Hans","year":"2004","journal-title":"Blood"},{"issue":"20","key":"pone.0307253.ref004","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1182\/blood-2016-01-643569","article-title":"The 2016 revision of the World Health Organization classification of lymphoid neoplasms","volume":"127","author":"SH Swerdlow","year":"2016","journal-title":"Blood"},{"issue":"5","key":"pone.0307253.ref005","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1182\/blood-2017-04-737320","article-title":"How I treat double-hit lymphoma","volume":"130","author":"JW Friedberg","year":"2017","journal-title":"Blood"},{"issue":"28","key":"pone.0307253.ref006","doi-asserted-by":"crossref","first-page":"3460","DOI":"10.1200\/JCO.2011.41.4342","article-title":"Immunohistochemical double-hit score is a strong predictor of outcome in patients with diffuse large B-cell lymphoma treated with rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone","volume":"30","author":"TM Green","year":"2012","journal-title":"J Clin Oncol"},{"key":"pone.0307253.ref007","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.3389\/fphar.2018.01497","article-title":"Correlation Between C-MYC, BCL-2, and BCL-6 Protein Expression and Gene Translocation as Biomarkers in Diagnosis and Prognosis of Diffuse Large B-cell Lymphoma","volume":"9","author":"Y Zhang","year":"2018","journal-title":"Front Pharmacol"},{"issue":"7","key":"pone.0307253.ref008","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1038\/s41375-022-01620-2","article-title":"The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Lymphoid Neoplasms","volume":"36","author":"R Alaggio","year":"2022","journal-title":"Leukemia"},{"key":"pone.0307253.ref009","unstructured":"Intragamtornchai T, Wudhikarn K, Chansung K, Prayongratana K, Julamanee J, Laoruangroj C, et al. Guideline for Diagnosis and Treatment for Lymphoma. The Thai Society of Hematology. 2022 Dec 8 [Cited 2024 May 31] https:\/\/tsh.or.th\/file_upload\/files\/Lymphoma%20Guideline%202022.pdf"},{"issue":"6","key":"pone.0307253.ref010","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1002\/ajh.21406","article-title":"Role and prognostic significance of the Ki-67 index in non-Hodgkin\u2019s lymphoma","volume":"84","author":"A Broyde","year":"2009","journal-title":"Am J Hematol"},{"issue":"3","key":"pone.0307253.ref011","first-page":"837","article-title":"The prognostic role of Bcl-2, Ki67, c-MYC and p53 in diffuse large B-cell lymphoma","volume":"58","author":"AM P\u0103tra\u015fcu","year":"2017","journal-title":"Rom J Morphol Embryolog"},{"issue":"3","key":"pone.0307253.ref012","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1002\/ajh.23638","article-title":"Sites of extranodal involvement are prognostic in patients with diffuse large B-cell lymphoma in the rituximab era: an analysis of the Surveillance, Epidemiology and 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