Survival analysis according to the MYC protein expression and MYC/BCL2 rearrangement status. (A) Distribution and association of MYC staining intensity and rearrangement status. Each lymphoma cell was judged for staining intensity as strong, medium, weak, or none by image analysis. The percentage of cells with either positive intensity and those with strong intensity in each case was automatically calculated. The y-axis represents the proportion of MYC-positive cells. The x-axis represents the individual case of the training set (n = 218), arrayed according to their overall percentage of MYC-positive cells from left (highest) to right (lowest). Cases with MYC rearrangement are shown as red bars, and cases without rearrangement are shown as blue bars. Light blue/red bars display the overall percentage, and dark-colored bars represent the percentage of cells with strong staining intensity in each case. There are significant differences of MYC IHC percentages between patients with and without MYC rearrangement (percentages of both positive-stained and strongly stained cells; P < .0001, respectively, Mann-Whitney U test). (B-C) PFS and OS of patients with DLBCL in the training set based on percentages of MYC protein expression obtained by the image analysis. An optimal cutoff for MYC protein expression is determined using X-Tile software (version 3.6.1; Yale University School of Medicine, New Haven, CT) with highest χ² value. (D-E) PFS and OS of the patients with DLBCL in the training set based on MYC/BCL2 rearrangements by FISH analysis. BCL2−, BCL2 rearrangement-negative; BCL2+, BCL2 rearrangement-positive; MYC−, MYC rearrangement-negative; MYC+, MYC rearrangement-positive.