The effect of lymphocyte infiltration on survival in primary tumor and omental metastasis in ovarian cancer

Objective: The aim of this study is to compare lymphocyte infiltration between early and advanced stage ovarian carcinoma as well as between primary tumor and metastatic implant and to investigate the effect of lymphocyte infiltration on survival. Materials and Methods: Patients who were operated for malignant ovarian carcinoma between 1997-2008 in Ege University Faculty of Medicine, Department of Obstetrics and Gynecology and who has had a follow up of at least 12 months were included in this study. Demographic and surgical data and pathology results (stage, grade and histological subtype) were collected. Disease-free and overall survivals were recorded. CD3, CD4, CD8, CD20 (Ventana Medical Systems, Tucson, AZ) and FoxP3 (Abcam, USA) expressions were evaluated immunohistochemically on sections from paraffin-embedded tissues. The relationship between expression levels and the survival of the patients were evaluated. Results: Sixty-two patients who were operated for ovarian carcinoma were evaluated. 21 of them were early stage (stage I-II) and 42 of them were advanced stage (stage III-IV). In 14 of advanced stage patients, metastatic paraffin-embedded tissues from the greater omentum were obtained and primary tumor and the metastatic lesions were also compared. In advanced stage cases, preoperative serum CA125 level, the ratio of serous histology and high-grade tumors were significantly higher according to early stage cases. Median follow up was 87 months. Disease free survival (DFS) was 108 months and overall survival (OS) was 111 months in early stage patients where as DFS was 36.4 months and OS was 74.6 months for advanced stage patients (p=0.0001 for DFS and p=0.006 for OS). In all cohort of patients, CD3+ and CD8+ T lymphocyte infiltration were significantly higher in patients with high-grade tumors, advanced stage tumors and the patients with omental metastasis (for CD3 p=0.0001, p=0.029, p=0.016; for CD8 p=0.044, p=0.002, p=0.046, respectively). DFS was significantly lower among patients with CD8+ T lymphocytes (p=0.028). 5 year DFS rate was 67% among patients with CD8+ T lymphocyte infiltration, where it was 39% in patients without CD8+ T lymphocyte infiltration. There was no difference for OS in this group. There were no correlation between other antigen expressions and the survival. There was no correlation between T lymphocyte infiltration and survival in the metastatic omental lesion. Conclusion: CD3+ and CD8+ T lymphocyte infiltrations were related with advanced stage, high-grade tumor and the omental metastasis in ovarian cancer. DFS was significantly shorter in patients with CD8+ T lymphocyte infiltration. CD3+ and CD8+ T lymphocyte infiltrations were related with poor prognosis in ovarian cancer.