Density of tumor-infiltrating FOXP3+T cells as a response marker for induction chemoradiotherapy and a potential prognostic factor in patients treated with trimodality therapy for locally advanced non-small cell lung cancer

Purpose: To examine the relationship between the density of tumor-infiltrating T cell subpopulations and the pathological response to induction chemoradiotherapy (CRT) in patientswith locally advanced NSCLC, and to assess the impact of T cell density on patient prognosis.

Methods: A total of 64 patients with c-stages IIA-IIIB NSCLC who underwent induction CRT followed by R0 surgery were enrolled. Tumor-infiltrating T cells expressing eitherFOXP3 or CD8 were detected by immunohisto chemical staining.

Results: Mean numbers of tumor-infiltrating FOXP3+ T cells were 39.9 for patients withminor pathological responses (n = 9), 18.4 for those with major pathological responses(n = 25), and 12.9 for those with complete pathological responses (n = 30; P <0.001). The number of CD8+ T cells was not associated with pathological responses. Patients with lower FOXP3+ T cell densities showed better survival, although the difference was not statistically significant.

Conclusion: Our study demonstrated that the density of tumor-infiltrating FOXP3+ Tcells indicated the degree of response for induction CRT and prognosis in patients treatedwith trimodality therapy for locally advanced NSCLC, suggesting that FOXP3+ T cellsmay be target for adjunct immunotherapy.