Introduction Objective: To explore the cancer-associated fibroblasts (CAFs) and CD8⁺ T cells tumor-to-stroma ratio (T:S ratio) in cervical cancer tissue and its association with the clinicopathological indexes, and to study the predictive significance of CAFs combined with CD8⁺ T cells T:S ratio in lymph node metastasis of cervical cancer.

Methods One hundred and ten cervical cancer tissues and thirty-nine biopsy tissues from patients were investigated immunocytochemically for the CAFs and the account of CD8⁺ T cells using the streptavidin-biotin-peroxidase method with respective monoclonal antibodies. The statistical correlation analysis was carried out using Spearman’s correlation test and χ2 test analysis by the SPSS system.

Results Statistical analysis also revealed a correlation (r=-0.690; P<0.001) between CAFs and CD8⁺ T cells T:S ratio in cervical cancer. It was found that a higher CAFs and CD8⁺ T cells T:S ratio had a significant correlation with lymph node metastases (P < 0.001). To further analysis, the combination of CAFs and CD8+ T cells T:S ratio correlated with lymph node metastases (P < 0.001). ROC curves analysis showed that the ROC curves areas for CAFs, CD8⁺ T cells T:S ratio, and combination of both are 0.879 (95%CI 0.809–0.946), 0.747 (95%CI 0.654–0.841) and 0.951 (95%CI 0.912–0.991). The prediction model was verified by biopsy specimens and consistent results were obtained.

Conclusion/Implications Conclusions: The combination of CAFs and CD8⁺ T cells T:S ratio has a high predictive value for lymph node metastasis in patients with cervical cancer. Their sensitivity and specificity are high, indicating they may hold considerable clinical value.