Immunoregulatory Forkhead Box Protein p3-Positive Lymphocytes Are Associated with Overall Survival in Patients with Pancreatic Neuroendocrine Tumors

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• 作者：Philip R. de Reuver ; MD ; PhD^a ; ^{Philipdereuver@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Shreya Mehta ; MD^a ; Preetjote Gill ; MD^a ; Juliana Andrici ; MD^b ; Lisa D'Urso ; BSc^b ; Adele Clarkson ; BSc^b ; Anubhav Mittal ; MBChB ; PhD ; FRACS^a ; Thomas J. Hugh ; MD ; FRACS^a ; Jaswinder S. Samra ; D Phil ; FRACS^a ; ^c ; Anthony J. Gill ; MD ; FRCPA^b
• 关键词：FoxP3+ ; Forkhead box protein p3-positive ; HR ; hazard ratio ; PNET ; pancreatic neuroendocrine tumor ; TMA ; tissue microarray ; Treg ; regulatory T cell
• 刊名：Journal of the American College of Surgeons
• 出版年：2016
• 出版时间：March 2016
• 年：2016
• 卷：222
• 期：3
• 页码：281-287
• 全文大小：557 K

文摘

Forkhead box protein p3-positive (FoxP3⁺) regulatory T cells (Tregs) suppress host T-cell-mediated immune responses, limit surveillance against cancers, and have been associated with a poor prognosis.

Study Design

This study aims to identify the prognostic significance of FoxP3⁺ Tregs in pancreatic neuroendocrine tumors (PNETs). Patients diagnosed with PNETs between 1992 and 2014 (n = 101) were included in this retrospective analysis. Clinical data, histopathology, and expression of FoxP3⁺ Tregs and Ki-67 by immunohistochemistry were assessed. The association of these factors with survival was tested by log-rank test and in additional multivariable analysis.

Results

A total of 101 patients were included in this study. Mean age was 58.0 years (range 18 to 87 years) and median tumor size was 25 mm (range 8 to 160 mm). The degree of infiltration of tumor by FoxP3⁺ Tregs was graded as 0 (n = 75), 1 (n = 15), or 2 (n = 11). Median follow-up was 50 months (interquartile range 123 months; Q1 = 20 months and Q3 = 123 months). In univariate analyses, patient age older than 57 years, TNM stage III or IV, tumor size >25 mm, Ki-67 labeling index >20, and a high number of FoxP3⁺ tumor-infiltrating lymphocytes were significantly associated with poorer overall survival. In multivariable analyses, FoxP3⁺ expression score of 2 (hazard ratio = 6.9; 95% CI 1.4–34.4) was the only statistically significant predictor for overall mortality.

Conclusions

FoxP3⁺ Treg expression is an independent prognostic factor in patients with PNETs, associated with statistically significant shorter overall survival. There is a role for additional research into the immune-mediated role of FoxP3⁺ Tregs in PNETs.