title: High CD4⁺ T cell density is associated with poor prognosis in patients with non-muscle-invasive bladder cancer.
abstract: OBJECTIVE
  The aim of this study was to investigate the clinical significance of CD4(+) T cells in non-muscle-invasive bladder cancer (NMIBC) tissues in situ.
  
  
  METHODS
  Immunohistochemistry was used to examine the distribution of CD4(+) T cells in 131 NMIBC tissues. Kaplan-Meier analysis and Cox proportional hazards regression models were applied to estimate overall survival (OS) and recurrence-free survival (RFS).
  
  
  RESULTS
  NMIBC patients were divided into two groups based on the median frequency of CD4(+) T cells (median, 1/×400 high resolution). On univariate analysis, CD4(+) T cell density was inversely associated with overall survival (P = 0.01). In those patients with high CD4(+) T density, 5-year OS rates was only 77%, compared with 86% in those with low density, respectively. Although CD4(+) T cell density showed no prognostic significance for RFS (P = 0.36), 5-year RFS rates of patients with high CD4(+) T density (58%) was lower than those of patients with low CD4(+) T density (65%, respectively). By multivariate analysis, tumor infiltrating CD4(+) T cell density emerged as an independent prognostic factor for OS (HR, 2.75; P = 0.004). In addition, no association was found between CD4(+) T cell density and any clinicopathological variables (P > 0.05).
  
  
  CONCLUSIONS
  Our findings suggest that CD4(+) T cells could potentially serve as a poor prognostic marker for patients with NMIBC.
authors.affiliation: Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University Jinan, Shandong, China ; Department of Urology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Qinglei
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Oncology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Chongli
authors.initials: C
authors.lastname: Hao
authors.affiliation: Department of Urology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Guangzhou
authors.initials: G
authors.lastname: Cheng
authors.affiliation: Department of Urology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Urology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Pathology, Tengzhou Central People's Hospital Zaozhuang, Shangdong, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Li
authors.affiliation: Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University Jinan, Shandong, China.
authors.forename: Juhui
authors.initials: J
authors.lastname: Qiu
authors.affiliation: Department of Urology, Shandong Provincial Hospital Affiliated to Shandong University Jinan, Shandong, China.
authors.forename: Kejia
authors.initials: K
authors.lastname: Ding
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000276:immunology; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D002295:Carcinoma, Transitional Cell / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D001749:Urinary Bladder Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor
keywords: CD4; T cells; non-muscle-invasive bladder cancers (NMIBC); prognosis