Introduction/Background Tumor-infiltrating lymphocytes (TILs) have a central role in the control of tumor growth, distant progression, treatment response, and survival in most solid tumors. Their role as a potential biomarker has been poorly investigated in cervical malignancy. The study aimed to evaluate the correlation between TILs topography, clinical characteristics, and patient outcomes in patients with cervical cancer treated with chemo-radiation.

Methodology Patients with locally advanced cervical cancer, negative aortic pretherapeutic FDGPET/CT uptake, available clinical data and FFPE material, and pre- and post-treatment MRI treated at the University Cancer Institute of Toulouse, France, were selected. Imaging was centrally reviewed, and intraepithelial and stromal tumor-infiltrating lymphocytes count was performed by an expert gynecologic oncology pathologist.

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Abstract 2022-RA-802-ESGO Figure 1

Overall survival according to intra-tumor lymphocytes infiltration 0–1 vs >1

Results TILs were assessed in 86 patients. 29 patients (34.9%) were considered as highly infiltrated by intraepithelial TILs (>1%), and 26 patients (30.2%) had a high stroma TILs infiltrate above 60%. Low intraepithelial TILs were associated with higher body mass index (25.5 versus 21.8 in the iTILs >1% group, p=0.0221), higher pretreatment MRI tumor size (compared to median tumor size, 31 patients (63.3%) were larger in the iTILs 0–1% group versus 11 patients (39.3%) in the iTILs >1% group (p=0.0421)).Low intraepithelial TILs were also associated with higher para-aortic lymph node metastasis (8 (14.8%) versus 1 (3.4%)) and poorer overall survival (figure 1), but these differences did not reach statistical significance.

Conclusion Our results suggest that intraepithelial infiltrating lymphocyte density is a potential prognostic non-invasive biomarker in patients treated with CRT for LACC. Furthermore, TILs seem to be associated with loco-regional tumor spread, and survival. These results need to be validated in larger series including the analysis of TILs subtypes.