Cancer Immunology, Immunotherapy

, Volume 59, Issue 6, pp 909–919 | Cite as

Foxp3+ cell infiltration and granzyme B+/Foxp3+ cell ratio are associated with outcome in neoadjuvant chemotherapy-treated ovarian carcinoma

  • Martin Pölcher
  • Michael Braun
  • Nicolaus Friedrichs
  • Christian Rudlowski
  • Eva Bercht
  • Rolf Fimmers
  • Axel Sauerwald
  • Mignon-Denise Keyver-Paik
  • Kirsten Kübler
  • Reinhard Büttner
  • Walther C. Kuhn
  • Juan-José Hernando
Original Article


Preoperative neoadjuvant chemotherapy (NAC) can significantly reduce tumour burden in patients with primarily unresectable chemosensitive tumours, allowing a more complete cytoreduction during debulking surgery and facilitating evaluation of tumour chemosensitivity, identification of appropriate treatment options and improvement of intervention protocols. In this study, we investigate, using immunohistochemistry, the impact of platinum/taxane-based NAC (NAC) on tumour-infiltrating lymphocytes (TILs) in advanced epithelial ovarian cancer (EOC) and their relationship with clinical outcome. All patients had clinical response, as shown by ascites volume and CA125 levels compared to pre-treatment findings. NAC intervention significantly increased CD4+, CD8+ and granzyme B+ infiltration while Foxp3+ accumulation remained unaffected. TILs were prognostically neutral for both progression-free survival (PFS) and overall survival (OS) before NAC. In contrast, after NAC, elevated granzyme B+ infiltration displayed a tendency for improved PFS (log-rank 0.064). Further, low Foxp3+ cell density was associated with longer PFS, as compared with strong Foxp3+ infiltration (median 20.94 vs. 11.24 months; log-rank 0.0001) and with improved OS (median 30.75 vs. 16.04 months, respectively; log-rank 0.056), demonstrating clear prognostic significance for PFS. In addition, high granzyme B+/Foxp3+ ratio post-NAC strongly correlated with improved PFS compared to low granzyme B+/Foxp3+ cell ratio (median 17.88 vs. 11.24 months, respectively), and showed to be a favourable prognostic factor for PFS (log-rank 0.014). Our findings indicate that NAC elicited an immunologic profile in which low immunosuppressive Foxp3+ infiltration and elevated numbers of activated granzyme B+ cells were significantly associated with EOC-specific PFS, suggesting a contribution of immunologic effects to improved clinical outcome.


Neoadjuvant chemotherapy Ovarian cancer TILs CD8/CD4 ratio Foxp3 Granzyme B 



This is a single institution analysis of clinical data collected within a multicenter phase 2 trial, PRIMOVAR, Identifier: NCT00551577, sponsored by Sanofi-Aventis Deutschland GmbH. We thank Christiane Esch for technical assistance with immunohistochemistry.

Conflict of interest statement

Walther Kuhn (principal investigator) received research funding from Sanofi-Aventis. All other authors indicated no potential conflict of interest.


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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Martin Pölcher
    • 1
  • Michael Braun
    • 1
  • Nicolaus Friedrichs
    • 2
    • 4
  • Christian Rudlowski
    • 1
  • Eva Bercht
    • 1
  • Rolf Fimmers
    • 3
  • Axel Sauerwald
    • 1
  • Mignon-Denise Keyver-Paik
    • 1
  • Kirsten Kübler
    • 1
  • Reinhard Büttner
    • 2
  • Walther C. Kuhn
    • 1
  • Juan-José Hernando
    • 1
  1. 1.Department of Gynaecology and Obstetrics, Centre for Integrated Oncology BonnBonn University Medical CentreBonnGermany
  2. 2.Institute of Pathology, Centre for Integrated Oncology BonnBonn University Medical CentreBonnGermany
  3. 3.Institute for Medical Biometry, Informatics, and EpidemiologyBonn University Medical CentreBonnGermany
  4. 4.Zentrale Klinische ForschungFreiburg UniversityFreiburgGermany

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