title: Immune phenotype predicts risk for posttransplantation squamous cell carcinoma.
abstract: Cutaneous squamous cell cancer (SCC) affects up to 30% of kidney transplant recipients (KTRs) within 10 years of transplantation. There are no reliable clinical tests that predict those who will develop multiple skin cancers. High numbers of regulatory T cells associate with poor prognosis for patients with cancer in the general population, suggesting their potential as a predictive marker of cutaneous SCC in KTRs. We matched KTRs with (n = 65) and without (n = 51) cutaneous SCC for gender, age, and duration of immunosuppression and assessed several risk factors for incident SCC during a median follow-up of 340 days. Greater than 35 peripheral FOXP3(+)CD4(+)CD127(low) regulatory T cells/microl, <100 natural killer cells/microl, and previous SCC each significantly associated with increased risk for new cutaneous SCC development (hazard ratio [HR] 2.48 [95% confidence interval (CI) 1.04 to 5.98], HR 5.6 [95% CI 1.31 to 24], and HR 1.33 [95% CI 1.15 to 1.53], respectively). In addition, the ratio of CD8/FOXP3 expression was significantly lower in cutaneous SCC excised from KTRs (n = 25) compared with matched SCC from non-KTRs (n = 25) and associated with development of new cutaneous SCCs. In summary, monitoring components of the immune system can predict development of cutaneous SCC among KTRs.
authors.affiliation: Transplantation Research Immunology Group, Nuffield Department of Surgery, Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital, Oxford, United Kingdom. robert.carroll@health.sa.gov.au
authors.forename: Robert P
authors.initials: RP
authors.lastname: Carroll
authors.forename: David San
authors.initials: DS
authors.lastname: Segundo
authors.forename: Kevin
authors.initials: K
authors.lastname: Hollowood
authors.forename: Teresa
authors.initials: T
authors.lastname: Marafioti
authors.forename: Taane G
authors.initials: TG
authors.lastname: Clark
authors.forename: Paul N
authors.initials: PN
authors.lastname: Harden
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Wood
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000235:genetics* / Q000276:immunology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011183:Postoperative Complications / Q000276:immunology*; D011379:Prognosis; D012307:Risk Factors; D012878:Skin Neoplasms / Q000235:genetics* / Q000276:immunology*