Expression,Clinical Significance And Prognosis Of A20 And Pim-1 Protein In Diffuse Large B Cell Lymphoma

Objective:Diffuse large B cell lymphoma(DLBCL)is a relatively common nonHodgkin lymphoma(NHL).In recent years,with the advent of rituximab,the survival of patients has been greatly improved,but some patients still have relapse and drug resistance.A20 protein is a ubiquitin enzyme encoded by A20 tumor suppressor gene,which can negatively regulate the activity of NF-?B pathway,while Pim-1 is a serine threonine protein kinase protein encoded by carcinogenic gene.Activated NF-?B can increase the transcription of Pim-1 gene,resulting in high expression of Pim-1 protein,further regulate the proliferation,apoptosis,canceration of tumor cells,and promote the invasion and migration of cancer cells.This study aims to explore the expression of A20 and Pim-1 in DLBCL,the correlation between the two proteins,and the relationship between their expression and clinical characteristics,treatment and prognosis,so as to provide some references for the prognosis and treatment of DLBCL.Method:1.99 patients of DLBCL patients diagnosed by the Fourth Hospital of Hebei Medical University from 2010-11 to 2017-09 were selected as the research object,with complete clinical data.The expression of A20 and Pim-1 protein were detected by immunohistochemical method for all patients.2.Using SPSS21.0 software to analyze the expression of A20 and Pim-1 in patients with clinical characteristics,prognosis and the correlation between the expression of both.Results:1.The positive expression rate of A20 protein was 20.20%(20 / 99)and Pim-1 protein was 74.74%(74 / 99).The expression of A20 protein and Pim-1 protein in DLBCL was negatively correlated with statistical significance(P=0.023).2.the expression of Pim-1 protein is correlated with ? 2 microglobulin(P=0.044)and age(P=0.024),but not with other clinical features such as gender,PS score,Ann Arbor stage,IPI score,lactate dehydrogenase,bone marrow infiltration,DLBCL subtype,splenomegaly,B symptom,large lump,extranodal involvement,Ki-67,primary site,(P> 0.05);The expression of A20 protein has no significant correlation with all the above clinical features(P > 0.05).3.Kaplan-Meier survival analysis was used to compare OS and PFS of patients.The results showed that the expression of A20(P=0.142,P=0.309)and Pim-1(P=0.395,P=0.266)proteins had no significant correlation with the prognosis of patients(P>0.05).The two proteins were not the main influencing factors of the prognosis of DLBCL.However,Ann Arbor stage,IPI score,lactate dehydrogenase,DLBCL subtype,splenomegaly,B symptom and chemotherapy regimen are the risk factors affecting prognosis,P < 0.05,the difference is statistically significant.4.COX regression multivariate analysis was used to list the above factors that may affect the prognosis.The results showed that IPI score,splenomegaly and chemotherapy regimen were independent risk factors affecting the prognosis of patients.5.Among 99 patients with DLBCL,R + CHOP/CHOPE group has better OS than CHOP/CHOPE group(P= 0.046);In 79 case of A20 negative expression,the R+CHOP/CHOPE group had better OS and PFS than the CHOP/CHOPE group(P = 0.018,P=0.032).In 74 case of Pim-1 positive expression,R+CHOP/CHOPE group has better OS and PFS than CHOP/CHOPE group(P = 0.014,P=0.016).Conclusions:1.the expression of A20 and Pim-1 in DLBCL is negatively correlated.2.The expression of Pim-1 protein is correlated with age and ? 2 microglobulin.3.A20 and Pim-1 proteins are not the main factors affecting the prognosis of DLBCL.4.The expression of the two proteins may be of guiding significance to the application of rituximab,and better OS and PFS can be obtained by applying rituximab to patients with A20 negative and Pim-1 positive.