Immunoscore Combining CD8, FoxP3 and CD68 Expression and Distribution Predicts the Prognosis of Head and Neck Cancer Patients

Abstract Purpose: The objective of this study was to assess immune cell infiltrates to develop an immunoscore for prognosis and to investigate its correlation with clinical data of patients with head and neck squamous cell carcinomaMethods: CD8, FoxP3 and CD68 were evaluated by immunohistochemistry in 258 carcinoma samples and counted in stromal and intra-tumoral compartments. Optimal cut-offs were assessed to divide population regarding to survival while the prognostic value was established by using Kaplan-Meier curves and Cox regression models for each immune marker alone and in combination.Results: We found with univariate analysis that infiltration of immune cells in both compartments was predictive for RFS and OS. Multivariate analysis revealed that CD8+ number influenced independently patient prognosis. Additionally, the combination of CD8, FoxP3 and CD68 in an immunoscore provided a significant association with OS (p=0.002, HR=9.87). Such immunoscore stayed significant (p=0.018, HR=11.17) in a multivariate analysis in comparison to tumour stage and histological grade which had lower prognostic values.Conclusion: Altogether, our analysis indicated that an immunoscore including CD8, FoxP3 and CD68 immunostaining was a strong, independent, and significant prognostic marker which could be introduced into the landscape of current tools to improve the clinical management of head and neck cancer patients.