Cervical cancer (CC) is the fourth most common malignancy of women worldwide, with 13,240 new cases and an estimated 4,170 deaths in 2018 in the United States, according to national cancer institute [www.cancer.gov]. The treatment depends on the stage; surgical treatment of invasive CC includes radical surgery [Landoni 1997], in locally advanced stages (IB2-IVA) the exclusive concomitant radio-chemotherapy treatment, currently constitutes the therapeutic standard [Rose PG 2002]. The neoadjuvant chemotherapy treatment followed by radical surgery in the IB2-IVA stages constitutes a therapeutic option widely used in Italy [Zanaboni F 2013]. As reported by a North American retrospective study with 564 patients the greatest incidence of recurrence is at 18-24 months from diagnosis, with 30-45% of cases are locoregional [Webb MJ 1980]. The International Federation of Obstetricians and Gynecologists (FIGO) tumor staging system, lymph node status, tumor size, histological grade, and depth of invasion were well known to be the prognostic factors of patients with CC [Li C 2016]. Clinical staging has been shown to be frequently inaccurate in predicting the prognosis of CC patients, especially in some patients with advanced disease [Tangjitgamol S 2014]. Therefore, a pretreatment and effective parameter to evaluate survival and prognosis of CC is necessary for decision-making concerning clinical therapy. For this reason new possible markers of tumor progression or response to treatment have been analyzed in inflammation and immunity processes. In particular, tumor infiltrating lymphocytes (TILs), have recently been correlated to prognosis in different cancers, including cervical cancer [Nakamura 2015]. Since the prognostic significance of TILs was proposed, much has been learned about the immunobiology of lymphocytes and the small molecules that govern the behavior of these cells. The aim of our study is to determine the prognostic role of TILs in cervical cancer.
Standard primary treatment for locally advanced cervical cancer (LACC) is radiotherapy (RT) with concomitant platinum-based chemotherapy (CT), which leads to a 30-50 % decrease in risk of death compared to radiotherapy alone. In the last decades, in order to improve the prognosis of these patients, the use of neoadjuvant chemotherapy (NACT) followed by radical surgery (RS) has emerged as a valid alternative with promising results. Over the last decades, many investigators proposed different therapeutic strategies in the attempt to improve the prognosis in patients with LACC and, in particular, in those at high risk of recurrence. For this reason, in the last decades, some authors advocated a new strategy in the attempt to reduce both local and distant recurrences. Despite these therapeutic options, the risk of recurrence remains high. In this scenario it remains essential to find new elements that can provide histopathological knowledge on the surgical section. The inflammatory infiltrate, with the different types of lymphocytes represent a new research target. the aim is to offer new prognostic factors of disease and to offer new immunomediated therapy in the future in order to improve the overall survival of patients with cervical cancer.