Prognostic value of tumor-infiltrating FoxP3+ T cells in gastrointestinal cancers: a meta analysis

Abstract

Purpose: Tumor-infiltrating FoxP3+ T cells have been reported in various human tumors, which impaired cell-mediated immunity and promoted disease progression. However, its prognostic value for survival in patients with different gastrointestinal cancers [hepatocellular carcinoma (HCC), colorectal cancer (CRC), gastric cancer (GC)] remains controversial.

Methods: Relevant literature was searched using PubMed, Embase, Cochrane, Ovid Medline and Chinese wanfang databases. A meta-analysis was conducted to estimate pooled survival and recurrence ratios. The odds ratio (OR) and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials.

Results: For HCC and GC, the overall survival at 1, 3 and 5-year of high FoxP3+ T cells infiltration patients were lower than low FoxP3+ T cells infiltration patients (P<0.05). The recurrences at 1, 3 and 5-year of high FoxP3+ T cells infiltration patients were higher than low FoxP3+ T cells infiltration patients (P<0.001). But for CRC, the overall survival at 1, 3 and 5-year of high FoxP3+ T cells infiltration patients were higher than low FoxP3+ T cells infiltration patients (P<0.001). There were no differences in 1, 3 and 5-year recurrences between high and low FoxP3+ T cells infiltration patients (P>0.05).

Conclusions: Our findings suggested that tumor-infiltrating FoxP3+ T cells were a factor for a poor prognosis for HCC and GC, but a good prognosis for CRC.

Figure 1. Forest plot of Hazard ratio (HR) for survival of HCC patients.

Fixed effect model of odds ratio for survival of follow-up 1(A), 3-year (B) and random effect model of odds ratio for survival of follow-up 5-year (C) of HCC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.

Figure 2. Forest plot of HR for recurrence of HCC patients.

Fixed effect model of odds ratio for recurrence of follow-up 1(A), 5-year (C) and random effect model of odds ratio for recurrence of follow-up 3-year (B) of HCC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.

Figure 3. Forest plot of HR for survival of CRC patients.

Fixed effect model of odds ratio for survival of follow-up 1 (A), 3 (B), 5-year (C) of CRC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.

Figure 4. Forest plot of HR for recurrence of CRC patients.

Random effect model of odds ratio for recurrence of follow-up 1 (A), 3 (B), 5-year (C) of CRC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.

Figure 5. Forest plot of HR for survival of GC patients.

Random effect model of odds ratio for survival of follow-up 1 (A), 3 (B), 5-year (C) of GC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.

Figure 6. Forest plot of HR for recurrence of GC patients.

Fixed effect model of odds ratio for recurrence of follow-up 1 (A), 3 (B), 5-year (C) of GC patients after surgery: high FoxP3⁺ T cells infiltration patients vs low FoxP3⁺ T cells infiltration patients.