title: Stromal regulatory T-cells are associated with a favourable prognosis in gastric cancer of the cardia.
abstract: BACKGROUND
  Recent evidence suggests that CD4+CD25+FoxP3+ regulatory T-cells (Treg) may be responsible for the failure of host anti-tumour immunity by suppressing cytotoxic T- cells. We assessed the prognostic significance of tumour infiltrating lymphocytes (TIL) in intestinal-type gastric cardiac cancer.
  
  
  METHODS
  Tumour infiltrating lymphocyte (TIL) subsets and tumour infiltrating macrophages (TIM) were investigated in 52 cases using tissue microarrays. The interrelationship between the cell populations (CD3+, CD8+, CD20+, CD68+, GranzymeB+, FoxP3+) in different compartments and NED-survival was investigated (median follow-up time: 61 months).
  
  
  RESULTS
  Intraepithelial infiltration with TIL and TIM including Treg was generally low and not related to NED-survival. However, patients with large numbers of FoxP3+ Treg in the tumour stroma (>125.9 FoxP3+TILs/mm2) had a median survival time of 58 months while those with low FoxP3+ TIL counts (<125.9 FoxP3+TILs/mm2) had a median survival time of 32 months (p = 0.006). Patients with high versus low stromal CD68+/FoxP3+ cell ratios in primary tumour displayed median survivals of 32 and 55 months, respectively (p = 0.008).
  
  
  CONCLUSIONS
  Our results suggest that inflammatory processes within the tumour stroma of gastric intestinal-type adenocarcinomas located at the gastric cardia may affect outcome in two ways. Tumour-infiltrating macrophages are likely to promote carcinogenesis while large numbers of Treg are associated with improved outcome probably by inhibiting local inflammatory processes promoting carcinogenesis. Thus, inhibition of Treg may not be a feasible treatment option in gastric adenocarcinoma.
authors.affiliation: Institute for Pathology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany. Matthias.Haas@uk-erlangen.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Haas
authors.forename: Arno
authors.initials: A
authors.lastname: Dimmler
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Gerhard G
authors.initials: GG
authors.lastname: Grabenbauer
authors.forename: Gerald
authors.initials: G
authors.lastname: Niedobitek
authors.forename: Luitpold V
authors.initials: LV
authors.lastname: Distel
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000473:pathology*; D000368:Aged; D002299:Cardia / Q000473:pathology*; D051858:Forkhead Transcription Factors / Q000378:metabolism; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology; D008207:Lymphatic Metastasis / Q000473:pathology; D008214:Lymphocytes / Q000473:pathology; D008264:Macrophages / Q000473:pathology; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D017154:Stromal Cells / Q000473:pathology*; D050378:T-Lymphocytes, Regulatory / Q000378:metabolism / Q000473:pathology*
chemical_list: C418974:FOXP3 protein, human; D051858:Forkhead Transcription Factors