Tumor-to-stroma cd8⁺ t cells ratio combined with cancer-associated fibroblasts: an innovative approach to predicting lymph node metastases of cervical cancer

Purpose: Precise identification of lymph node metastases is vital for the management of cervical cancer. However, the existing diagnostic methods for lymph node metastases have certain drawbacks. In this study, we aim to explore the expression of cancer-associated fibroblasts (CAFs) and tumor-to-stroma CD8⁺ T cells ratio (CD8⁺ T cells T:S ratio) and its association with lymph node metastases of cervical cancer.

Methods: Hundred and ten cervical cancer tissues and 39 biopsy tissues from patients were investigated immunocytochemically for the expression of CAFs and CD8⁺ T cells. The statistical correlation analysis was carried out using the SPSS system.

Results: A strong and statistically significant negative correlation (r= - 0.690; P < 0.001) was observed between CAF density and CD8⁺ T cells T:S ratio. Not only were CAFs density and CD8⁺ T cells T:S ratio correlated with lymph node metastases respectively (P < 0.001), but the combination of them also significantly correlated with lymph node metastases (P < 0.001). Then, we constructed the combined diagnosis model (Logit (P) = - 4.446 + 0.300 × CAFs + 0.752 × CD8+ T cells T:S Ratio) of cervical cancer lymph node metastases. ROC curves analysis showed that the ROC curves areas for CAFs, CD8⁺ T cells T:S ratio, and a combination of both are 0.879, 0.747, and 0.951. Then, the prediction model was verified by biopsy specimens and consistent results were obtained.

Conclusions: The combination of CAF density and CD8⁺ T cells T:S ratio has a significant predictive value for lymph node metastases in patients with cervical cancer.