VSIR and metastatic malignant neoplasm in the lymph nodes: In lung adenocarcinoma, the high expression of VISTA in CD4+ T cells is associated with a reduction in the overall survival (P = 0.03), lymph node metastasis (P = 0.05) and cytokine production inhibition, including IL2/4/10/17, and IFN-γ, the inhibitory tumor immune microenvironment may be associated with the poor prognosis of patients, moreover, the increased infiltration of CD4+ VISTA+ T cells is associated with advanced pathology Node (pN) staging but not for Tumor (pT) staging, however, the role of VISTA in lung squamous carcinoma or other types is still unclear [96].