As a consequence, this immunogenic disease requires a highly immunosuppressive microenvironment to progress and metastasize (48, 49) which has been demonstrated in tumor-positive lymph nodes where high Treg levels, low CD8+ T cell/Treg ratio and high levels of PD-L1+ and HLA-DR+ myeloid cells were found (50). This evidence concerns the gene CD274 and neoplasm.