The predictive value of CD4, CD8, and C - reactive protein in the prognosis of schistosomal and non-schistosomal colorectal cancer

Abstract

Abstract Background: Although schistosomiasis has been basically eliminated, it has not been completely extinction in China and occasional outbreaks occur in Europe in recent years. The relationship between inflammation caused by Schistosoma japonicum and colorectal cancer is still obscure, and the inflammation based prognostic systems of schistosomal colorectal (SCRC) has rarely been reported. Aim: To explore the different roles of tumor infiltrating lymphocytes (TILs) and C-reactive protein (CRP) in SCRC and in Non-schistosomal CRC (NSCRC), providing a possible predictive system to evaluate outcomes and to improve the risk stratification for CRC patients, especially for CRC patients with schistosomiasis. Methods: 351 CRC tumours were evaluated for density of CD4+, CD8+ T cells and CRP in intratumoural and stromal compartments by immunohistochemical using tissue microarray. Results: There were no association between TILs and CRP and schistosomiasis. Multivariate analysis identified stromal CD4 (sCD4) (p=0.038), intratumoural CD8 (iCD8) (p=0.003), schistosomiasis (p=0.045) as independent prognostic factors for overall survival (OS) in the whole cohort; and sCD4 (p=0.006) and iCD8 (p=0.020) were independent prognostic factors for OS in the NSCRC and SCRC set, respectively. Besides, we found that there were no differences of TILs and CRP, which were distributed in different areas of tumor tissue, between CRC patients with and without schistosomiasis. Conclusion: The results remind us that different subtypes of TILs have distinguished biological behavior and function in the immune microenviroment of NSCRC and SCRC patients. Meanwhile, the findings require us to stratify patients with schistosomiasis and might facilitate patient counseling and management.