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The role of lymph node size and FOXP3+ regulatory T cells in node-negative colon cancer
  1. Bruno Märkl1,
  2. Beate Paul1,
  3. Tina Schaller1,
  4. Hallie Kretsinger1,
  5. Bernadette Kriening2,
  6. Gerhard Schenkirsch3
  1. 1Institute of Pathology, Klinikum Augsburg, Augsburg, Bayern, Germany
  2. 2Department of Visceral Surgery, Klinikum Augsburg, Augsburg, Bayern, Germany
  3. 3Clinical and Population-Based Cancer Registry of Augsburg, Augsburg, Bayern, Germany
  1. Correspondence to Dr Bruno Märkl, Institute of Pathology, Klinikum Augsburg, Stenglinstraße 2, Augsburg, Bayern 86156, Germany; Bruno.Maerkl{at}


Recently, we demonstrated that the intratumoural density of CD3+ and CD8+ T cells is independently prognostic and associated with lymph node (LN) harvest and LN size in node-negative colon cancer. We assumed that FOXP3+ T cells (Tregs) could be inversely associated with these LN features. Therefore, we performed a retrospective immunohistochemical analysis using an already well-characterised collection of stage I/II colon cancer cases. Receiver operating characteristic analysis revealed the optimal cut-off for predicting cancer-related death to be 70 FOXP3+ Tregs/mm2 at the invasion front. Other than T-stage, none of the relevant histopathological parameters were associated with the density of FOXP3+ cells. In particular, no relation to LN size and count were found. Cancer-specific survival was significantly improved in cases with high densities (115 vs 86 months; p=0.026) in univariable but not in multivariable analysis. In contrast to other cancers, FOXP3+ T cells are associated with a favourable outcome.


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  • Handling editor Cheok Soon Lee

  • Contributors BM and BK planned and designed the study; BP performed laboratory work; BM, TS and BP evaluated the slides; HK revised the manuscript critically; GS provided the follow-up data; BM, BP and GS analysed the data; BM performed the statistical calculations. All authors read and approved the manuscript.

  • Funding This work was supported by the Hermann-Egger-Stiftung.

  • Competing interests None declared.

  • Ethics approval Internal Review Board Klinikum Augsburg.

  • Provenance and peer review Not commissioned; externally peer reviewed.