Foxp3 expression in lymph node metastases in patients with head and neck cancer

Abstract

Introduction: The prevalence and activity of regulatory T cells in patients with cancer correlates with poor prognosis. These cells are characterized by their expression of Forkhead box protein-3 (Foxp3). Squamous cell carcinoma is the most prevalent type of cancer in the head and neck region with overall poor survival rates, also due to early spread of metastatic cells.

Material and methods: Primary tumor specimens as well as lymph node specimens harvested during neck dissection of 65 patients with a diagnosis of HNSCC were subjected to immunohistochemical and H-score analysis of Foxp3 expression. Demographics, diagnoses, histopathology and subsequent outcome were analyzed.

Results: The primary cancer was squamous cell carcinoma in all patients (male/female 55:10) with the following tumor locations: oral cavity n = 16, oropharynx n = 28, hypopharynx n = 11 and larynx n = 10 (Stage III n = 18; Stage IVA n = 45; Stage IVB n = 2). The H-score for Foxp3 expression in the primary lesion as well as metastatic lymph nodes was significantly higher in advanced stages compared to early stages with differences among tumor locations, which were not significant. High Foxp3 expression was associated with inferior overall survival rates at a mean follow-up of 83.4 months (6–204 months)

Conclusions: Foxp3 expression in HNSCC varied from the anatomical site and correlated positively with tumor stage and was associated with poor prognosis. Therefore, Foxp3 expressions in primary lesions as well as lymphogenic metastases appear to predict high-risk HSNCC patients. Novel therapeutic approaches targeting Foxp3⁺ cells might seem promising for this patient population.

Chinese abstract

简介：癌症患者调节性T细胞的肆孽和活动与预后不良相关。这些细胞的特征在于它们的Forkhead盒蛋白-3（Foxp3）的表达。鳞状细胞癌是头颈部最常见的癌症类型, 总体生存率差, 还因为转移细胞的早期扩散。

材料与方法：对65例诊断为HNSCC的患者进行颈淋巴结解剖过程中获得的原发肿瘤标本以及淋巴结标本进行了Foxp3表达的免疫组织化学和H评分分析。并分析了人口统计学、诊断、组织病理学及随后的结果。

结果：所有患者（男性/女性55:10）的原发性癌症均为鳞状细胞癌, 肿瘤位置如下：口腔, n = 16；口咽, n = 28；下咽喉, n = 11；喉, n = 10。（III期n = 18; IV期A n = 45; IV期B n = 2）。与早期阶段相比, 晚期的原发灶和转移淋巴结中Foxp3表达的H值明显较高；肿瘤位置会导致一点差异, 但无统计学意义。高Foxp3表达与平均随访83.4个月时（6-204个月）的较低总生存率相关。

结论：HNSCC中的Foxp3表达随着解剖部位不同而不同, 与肿瘤发展期呈正相关, 往往预后较差。因此, 原发灶和转移淋巴结中的Foxp3表达似乎预示着高风险的HSNCC患者。针对Foxp3⁺ 细胞的新型治疗方法对于这种患者人群来说似乎是有希望的。

Keywords:

• Head and neck cancer
• lymph node metastases
• Foxp3
• regulatory T cells

Disclosure statement

All authors declare that they have no conflict of interest.