Abstract
<h3>Context</h3> CD23 expression in follicular lymphoma (FL) is associated with better overall survival (OS). It is known that FL cases with inguinal lymph node lesions and large-cell morphology are characterized by CD23 expression, which is a distinctive feature of these patients whose prognosis is also favorable. However, the CD23 prognostic significance in various FL morphological grades and other tumor lesion localization is unclear. <h3>Objective</h3> To determine the CD23 expression prognostic value in different FL grades. <h3>Design</h3> CD23 expression pattern was evaluated by immunohistochemistry. Three groups of patients were identified: expression is absent (CD23neg), intense expression in all cells (CD23bright), expression is weak and/or only present in a portion of tumor cells (CD23dim). <h3>Patients</h3> The study included 206 FL patients, including 93 FL1–2 grade, 68 FL3A, 45 FL3B, and transformation into DLBCL. In 102 patients, inguinal region involvement was noted. <h3>Results</h3> In general, OS was similar for the CD23neg, CD23bright, and CD23dim groups. There was also no correlation between OS and CD23 expression in patients with and without iliac region involvement. However, we found that CD23 prognostic value depends on FL grade. In FL1–2 and aggressive FL, there was no association between OS and CD23 expression. In FL3A patients, OS in the CD23dim group was lower than in the CD23neg and CD23 bright groups. The 5-year OS in the CD23neg, CD23bright, and CD23dim groups were 91%, 87%, and 65%, respectively. The level of these differences tended to be significant (log-rank test, p=0.09). <h3>Conclusions</h3> The previously shown association between CD23 expression, lesion localization, and OS was not confirmed. However, CD23 expression pattern analysis revealed a fact not previously known. The intermediate CD23 expression pattern is an unfavorable prognostic factor in FL3A patients. It is worth noting that combining CD23dim with CD23neg into a single group resulted in a "favorable" status compared with the CD23bright group. Thus, expression cutoff is important, and we assume this phenomenon has not been previously noted because the true CD23bright value was not identified. The heterogeneous CD23 expression in the tumor population probably indicates clonal tumor heterogeneity, which correlates with an unfavorable disease course.
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