IDO And AHR Expression For R-CHOP Treatment Of Diffuse Large B-cell Lymphoma Prognosis Research

objective:Diffuse large B-cell lymphoma(DLBCL)is the most common subtype of non-Hodgkin's lymphoma(NHL).The R-CHOP program is a standard chemotherapy program for the treatment of diffuse large B-cell lymphoma,which allows 70%of patients to be cured.But there are still many patients in the treatment after a short period of time recurrence or progress and other results.So the prevention of recurrence or progress after treatment is the focus of clinical research.In recent years,it has been found that IDO is highly expressed in B cell tumors,and is closely related to tumor resistance and prognosis,which may be related to the abnormal activation of downstream IDO/Kyn/AHR signaling pathway.In this study,we mainly analyzed theexpression of IDO and AHR protein in the diffuse large B-cell lymphoma lesion by immunohistochemistry,and analyzed the relationship between the two and the pathologic features of DLBCL.DLBCL standard regimen R-CHOP treatment response and prognosis.Methods:From January 2007 to January 2016,78 cases of diffuse large B cell lymphoma were collected from Sichuan Provincial Tumor Hospital,20 cases of inflammatory hyperplasia group.All patients in the experimental group were all CD20 positive,the control group were all reactive hyperplasia.The expression levels of IDO and AHR in tumor were detected by immunohistochemistry.The correlation between IDO and AHR was analyzed,and the correlation between IDO and AHR was analyzed.All the data were analyzed by SPSS22.0 statistical software.The Pearson chi-square test and Fish exact probability method were used to analyze the count data,Log-rank single factor survival analysis and Cox proportional risk regression were used to analyze,the multivariate analysis.Results:(1)The overexpression rates of IDO and AHR in the DLBCL group were 48.72%and 57.69%,and were higher than that in the reactive hyperplasia group,and the expression of IDO and AHR in the proliferative group were respectively 15%and 30%.The difference between the two groups was statistically significant(PIDO=0.006,PAHR=0.027).(2)The expression level of IDO was correlated with Hans classification,clinical stage,B symptom,IPI score and Chemotherapy effect(X2 Hans classification=6.334,X2 clinical stage=11.734,X2B symptom=7.575,X2 IPI score=4.183,2Chemotherapy effect=10.471,PHans classification =0.012,Pclinical stage=0.001,PB symptom=0.006,P IPI score=0.041,P Chemotherapy effect=0.001);AHR expression level was correlated with Hans classification,clinical stage,B symptom and chemotherapy effect(X2 Hans classification=4.807,X2 clinical stage=4.807,X2B symptom=4.099,X2 chemotherapy effect=6.707,PHans classification=0.028,Pclinical Staging=0.028,PB symptoms=0.043,Pchemotherapy effect=0.010).The expression of IDO was significantly correlated with age,sex,extranodal invasion,ECOG and LDH(P>0.05).The expression of AHO was significantly correlated with age(P>0.05).There was no significant difference between the two groups(P>0.05).(3)There was a rank correlation between IDO and AHR(R= 0.367,P<0.001).(4)Log-rank single factor survival analysis(PFS)showed,Hans classification,B symptom,IPI score,IDO,AHR(PHans classification=0.027,PB symptom=0.005,PIPI score=0.007,PIDO=0.001,PAHR<0.001).There was a significant difference in the expression levels of Cox multivariate survival analysis,IDO,AHR and IPI scores(PIDO=0.040,PAHR=0.030,PIPI scores=0.031).Conclusion:1.IDO and AHR may be one of the factors that affect the poor outcome of R-CHOP treatment in patients with DLBCL.2.DLBCL patients in the choice of treatment programs,IDO and AHR high expression of a certain guiding significance.3.The combination of IDO or AHR inhibitors with R-CHOP may be one of the effective ways to improve the prognosis of DLBCL.