title: Composition of inflammatory cells regulating the response to concurrent chemoradiation therapy for HPV (+) tonsil cancer.
abstract: BACKGROUND
  Human papillomavirus (HPV) (+) tonsil squamous cell carcinoma (TSCC) responds well to concurrent chemoradiation therapy (CCRT) and demonstrates a favorable prognosis. However, cases of HPV (+) TSCC-related death remain unresolved. We evaluated the distribution and prognostic value of inflammatory cells in HPV (+) TSCC.
  
  
  METHODS
  We reviewed the medical records of 53 patients who were diagnosed with TSCC. HPV (+) TSCC was confirmed using HPV DNA PCR and immunohistochemical p16 overexpression. The numbers of CD4 (+), CD8 (+), and CD68 (+) stained cells were used to evaluate peritumoral lymphocyte infiltration. Patients were divided into two groups according to the mean numbers of stained cells and the mean ratios of each cell type.
  
  
  RESULTS
  HPV (+) was noted in 39 patients. During the follow-up period, 27 patients had no evidence of disease, 2 patients showed disease, and 10 patients died of disease. In this group, advanced T and N stages were not related to overall or disease-specific survival outcomes. The overall survival rate was affected by a high CD68 (+) (HR=19.8; P=0.040) and low CD8/CD4 ratio (HR=7.7, P=0.025). The disease-specific survival rate was affected by a high number of CD68 (+) cells (HR=15.2; P=0.03) and low CD8 (+)/CD4 (+) ratio (HR=3.3; P=0.04).
  
  
  CONCLUSIONS
  The number of CD68 (+) cells and the distribution of cytotoxic or immunosuppressive T lymphocytes could be determining factors for CCRT outcomes in HPV (+) TSCC patients.
authors.affiliation: Department of Otolaryngology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Yoon Se
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Pathology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Pathology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Kyung Ja
authors.initials: KJ
authors.lastname: Cho
authors.affiliation: Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Sung Bae
authors.initials: SB
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Otolaryngology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.affiliation: Department of Otolaryngology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.affiliation: Department of Otolaryngology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea. Electronic address: sykim2@amc.seoul.kr.
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D015704:CD4 Antigens / Q000378:metabolism; D016827:CD8 Antigens / Q000378:metabolism; D002294:Carcinoma, Squamous Cell / Q000378:metabolism / Q000628:therapy / Q000821:virology*; D059248:Chemoradiotherapy; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D008297:Male; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000378:metabolism / Q000628:therapy / Q000821:virology*; D011379:Prognosis; D014067:Tonsillar Neoplasms / Q000378:metabolism / Q000628:therapy / Q000821:virology*; D000097382:CD68 Molecule
chemical_list: D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D015704:CD4 Antigens; D016827:CD8 Antigens; C067980:CD68 antigen, human; D000097382:CD68 Molecule
keywords: CD4; CD8; Human papillomavirus; Inflammatory cells; Tonsil cancer; Tumor immunological microenvironment; Tumor-associated macrophage