J Cancer 2020; 11(1):57-68. doi:10.7150/jca.37033

Research Paper

High expression levels of TLR9 and PD-L1 indicates a poor prognosis in patients with angioimmunoblastic T-cell lymphoma: a retrospective study of 88 cases in a single center

Jingrong Qian1#, Hongxue Meng2#, Bowen Lv1#, Jie Wang1, Yingying Lu1, Liju Su3, Shu Zhao4✉, Wenhui Li1✉

1. Department of Clinical Laboratory, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China.
2. Department of Pathology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China.
3. Department of Clinical Laboratory, The First Hospital of Harbin, Harbin, Heilongjiang 150010, P. R. China.
4. Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150081, P. R. China.
#These authors contributed equally to this work.

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Citation:
Qian J, Meng H, Lv B, Wang J, Lu Y, Su L, Zhao S, Li W. High expression levels of TLR9 and PD-L1 indicates a poor prognosis in patients with angioimmunoblastic T-cell lymphoma: a retrospective study of 88 cases in a single center. J Cancer 2020; 11(1):57-68. doi:10.7150/jca.37033. Available from http://www.jcancer.org/v11p0057.htm

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Abstract

Background: The role of TLR9 expressed by tumor cells in evading immune surveillance was confirmed. PD-L1 expression in tumor cells plays a key role in tumor immune escape, which is associated with poor prognosis. However, the clinical relevance of TLR9 and PD-L1 expression in angioimmunoblastic T-cell lymphoma (AITL) has not been evaluated.

Materials and methods: In this study, we identified differentially expressed genes in AITL samples by bioinformatic analysis, and we first examined TLR9 and PD-L1 expression by immunohistochemical staining in patients with AITL and compared these data with clinical features and survival time.

Results: It was found that the expression of PD-L1 and multiple TLRs was higher in AITL than normal T-cell samples, and TLR9 and PD-L1 expression displayed complex interactions by bioinformatic analysis. The rates of TLR9 and PD-L1 high expression were 69% and 50%, respectively. High expression of either TLR9 or PD-L1 indicated a poor survival rate for patients with AITL. Multivariate analysis further confirmed that high expression levels of TLR9 and PD-L1 were unfavorable prognostic factors for AITL. We further found inferior overall survival in AITL with clinical features of ECOG status ≥ 2, advanced-stage, elevated serum LDH levels, elevated serum β2-MG levels, and high IPI score.

Conclusion: TLR9 and PD-L1 expression may be a novel predictor of prognosis for patients with AITL and may serve as potential therapeutic strategy.

Keywords: TLR9, PD-L1, angioimmunoblastic T-cell lymphoma, prognosis