Expression of CTLA-4 as a prognostic factor in nasopharyngeal carcinoma: a cross-sectional study

Introduction: Nasopharyngeal carcinoma (NPC) poses a significant health burden in Indonesia, often diagnosed in advanced stages and associated with significant morbidity and mortality. Immunotherapy, particularly targeting the CTLA-4 protein receptor, has emerged as a key treatment approach to enhance immune recognition of tumor cells. Despite its role as an immune checkpoint in malignancies, the potential of CTLA-4 mRNA expression in prognosis remains poorly studied. This study aims to evaluate the role of CTLA-4 expression as a prognostic factor in NPC to evaluate the improvement in host immune response in patients following chemoradiotherapy. Material and Methods: This cross-sectional study included patients diagnosed with stage III-IV NPC, measuring CTLA-4 mRNA levels before and after chemoradiotherapy using quantitative PCR. Staging was carried out in the group that had received chemoradiotherapy. Chemotherapy comprised cisplatin administration (once weekly at 30-40 mg/m2), followed by radiation therapy ([60]Co or 6-8 MV linear accelerator) for 20-36 sessions. Results: CTLA-4 mRNA expression positively correlated with NPC staging in patients both before and after chemoradiotherapy. Higher expression of CTLA-4 was associated with more advanced NPC staging, while lower expression of CTLA-4 was observed in patients having undergone chemoradiotherapy in NPC stages III and IV. Conclusion: CTLA-4 mRNA expression may serve as a prognostic marker for improvement in host immune response following chemoradiotherapy.