INFILTRATION BY IMMUNOCOMPETENT CELLS IN EARLY-STAGE INVASIVE-CARCINOMA OF THE UTERINE CERVIX - A PROGNOSTIC STUDY

In various tumor types dentritic cell, infiltration and the presence o f tumor-infiltrating lymphocytes have been associated with an improved clinical outcome. In the uterine cervix these immunocompetent cells h ave been associated with improved prognosis in high stage disease. The current study examines the significance of stromal and tumor T-lympho cyte infiltration together with S-100 positive dendritic cell infiltra tion in a series of 73 women with low stage (FIGO Ib) invasive squamou s and adenosquamous cervical carcinoma. Thirty four percent of cases c ontained S-100 positive dendritic cells. These were under-represented in cases showing pelvic recurrence or distant disease (1 of 11 compare d to 24 of 62 free of recurrence, P = 0.05) and over-represented in ca ses showing lymphatic/capillary space involvement (12 of 23 compared t o 13 of 46 without vascular space invasion, P = 0.05). The women were followed up for an average of 5.2 years and the five-year survival for women whose tumors contained S-100 positive dendritic cells was 92% c ompared to 73% for negative cases (P = 0.04). There was a significant association between a low density of tumor infiltrating T-cells and ri sk of pelvic lymph node spread and subsequent local or distant disease control failure (P = 0.008). A five year survival advantage was seen with five or more CD 3 positive tumor infiltrating T-lymphocytes per h igh power field (90%) compared to a lower count (68%) (P = 0.04). A si milar advantage could not be demonstrated for a high stromal infiltrat e of T-cells. As yet neither the specific mechanisms that induce these cells to infiltrate some cervical carcinomas nor the nature of the im munologicaI injury that the cells co-ordinate in tumor tissue are well understood.