PROGNOSTIC SIGNIFICANCE OF FOXP3 IN RADICALLY TREATED NON-SMALL CELL LUNG CANCER PATIENTS

Regulatory T-cells (Tregs), which are characterized by the expression of the transcription factor Forkhead box P3 (Foxp3), play a crucial role in modulating the immune response. While Tregs are primarily recognized for their immunosuppressive functions, their influence on the survival and prognosis of patients with non-small cell lung cancer (NSCLC) presents a complex and often variable picture. This variability can manifest in a range of outcomes, influencing patient prognosis in positive, negative, or neutral ways. Our study aims to delve into the prognostic significance of Foxp3 expression in patients undergoing radical treatment for NSCLC, seeking the relationship between Treg dynamics and patient outcomes. This study involved a cohort of forty-two patients diagnosed with non-small cell lung cancer (NSCLC) at stages IA to IIIB, all of whom underwent radical surgical intervention followed by an adjuvant regimen of platinum-based chemotherapy. The inclusion criteria were: patients who had previously received neoadjuvant chemotherapy or radiation therapy. Those who experienced postoperative complications, or individuals with significant concurrent health conditions were systematically excluded from participation. Comprehensive clinicopathological data for each patient were extracted from their medical records to ensure accuracy and reliability. To evaluate the presence of FOXP3-positive cells, we employed immunohistochemistry techniques and established a threshold of 23 cells per 1 mm². Patients were subsequently stratified into two distinct groups based on their FOXP3 expression levels: the low expression group (<23 cells/1 mm²) and the high expression group (≥23 cells/1 mm²). We compared clinical outcomes between these two groups to ascertain any significant differences. A statistical analysis utilizing the Mann-Whitney test, Chi-squared test, receiver operating characteristic (ROC) analysis, and the Kaplan-Meier method and Log-rank test to comprehensively evaluate the data. The density of Foxp3-positive lymphocytes within the tumor microenvironment exhibited a notable variability, ranging from 5 to as many as 72 cells per square millimeter. Interestingly, analysis revealed no significant associations between the levels of Foxp3 and the selected clinicopathological features of the patients. Moreover, a comparative evaluation showed no marked differences in Foxp3 expression between adenocarcinomas and squamous cell carcinomas with respect to the clinicopathological characteristics examined. Importantly, low versus high Foxp3 expression patients did not demonstrate significant disparities in recurrence-free survival or overall survival, as indicated by log-rank p-values of 0.1817 and 0.3944, respectively. However, a discernible trend emerged, suggesting that patients exhibiting lower levels of Foxp3 tended to experience improved RFS and OS outcomes. Research indicates that individuals exhibiting both low and high levels of Foxp3 demonstrate no significant differences in recurrence-free survival and overall survival. Furthermore, a lack of correlation between Foxp3 expression in adenocarcinomas and squamous cell carcinomas and their associated clinicopathological features has been observed. This variability in Tregs may play a crucial role in the discrepancies noted between Foxp3 expression levels and the survival outcomes of patients.