Hala Ahmed Zaghloul Isamil El Lathy, Ahlam Dohal and Miral Mashhour
Purpose: To link pretreatment tumor infiltrating T-lymphocytes (TILs) (CD8+, CD4+, FOXP3+) and systemic neutrophil to lymphocyte ratio (NLR) to different clinical/pathological elements. Consequently, emphasizing their impact in predicting the outcome in definitively treated cervical cancer patients.
Methods: The most relevant clinical/pathological factors were used to establish a link with pre-treatment NLR and densities of TILs (CD8+, CD4+, FOXP3+) in cervical biopsies. The predictive significance of pre-treatment TILs and NLR, both for disease free survival (DFS) and overall survival (OS) were evaluated using Log rank alongside Cox regression analysis.
Results: Radical hysterectomies followed by adjuvant radiation with or without chemotherapy were offered to 28 patients, while the remaining twenty eligible patients received curative concurrent chemo-radiation. Augmented levels of CD8+, CD8+/CD4+, while reduced levels of FOXP33+ and NLR were linked to node negative, radical hysterectomies and early stages. Cox-regression demonstrated that augmented levels for NLR and nodal disease were individually correlated to dismal prognosis with HR 3.06 (95%confidence interval [CI], 3.45-9.24), 5.63 (95% CI, 2.61-9.32) for OS and (HR 8.21 (95% CI, 4.21-16.53) and 5.32 (95% CI, 2.37-10.24)for DFS, respectively. On the contrary, FOXP3+≥19 and CD8+/CD4+< 2 had a substantial link to reduced OS (HR 4.37(95% CI, 2.48-12.37), 2.31(95% CI, 2.34-9.32) and worsened DFS (HR 3.61 ( 95% CI , 1.38-9.32), 4.32(95%CI, 3.12-8.34).
Conclusion: The pretreatment NLR, CD8+, FOXP3+and C8+/CD4+showed a substantial link to various clinical/pathological prognostic characteristics for curatively treated cervical cancer patients. Furthermore, the prognostic prospective of the tested indicators could be emphasized.
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