Tumour-associated CD66b + neutrophil count is an independent prognostic factor for recurrence in localised cervical cancer

Background:The prognostic impact of tumour-promoting immune cells in cervical cancer is unclear.Methods:Federation of Gynaecology and Obstetrics (FIGO) stage IB and IIA cervical cancer patients (N=101) were assessed for tumour-associated CD66b + neutrophils and CD163 + macrophages by immunohistochemistry in whole tissue sections using stereology. Results were correlated with previous results on tumour-infiltrating CD3 +, CD4 +, and CD8 + lymphocytes in the same cohort with recurrence-free survival (RFS) as end point.Results:The highest densities of CD66b + neutrophils and CD163 + macrophages were observed in the peritumoural compartment (median 53.1 cells mm-2 and 1.3% area fraction, respectively). Above median peritumoural and stromal CD66b + neutrophils and peritumoural CD163 + macrophages were significantly associated with short RFS. Multivariate analysis identified high peritumoural neutrophils (HR 2.27; 95% CI 1.09-4.75; P=0.03), low peritumoural CD8 + lymphocytes (HR 3.67; 95% CI 1.63-8.25; P=0.002), and lymph node metastases (HR 2.70; 95% CI 1.26-5.76; P=0.01) as independent prognostic factors for short RFS, whereas CD163 + macrophages were not significant. An index of combined intratumoral and peritumoral CD66b + neutrophils to CD8 + lymphocytes had good discriminatory power for each quartile with 5-year RFS of 92%, 80%, 62%, and 44% (P=0.001).Conclusion:Tumour-associated neutrophil count is an independent prognostic factor for short RFS in localised cervical cancer. Combining CD66b and CD8 may further improve prognostic stratification. These findings require prospective validation.