The explanation to why patients with high levels of CD4+PD-1+, CD4+TIGIT+, CD4+CTLA-4+, CD8+TIGIT+ cells in their TDLNs have a higher risk for recurrence could be that the expression of immune checkpoints can represent the exhaustion-state of the immune system or the ability of the tumor cells to escape the anti-cancer immunity. The gene discussed is CTLA4; the disease is neoplasm.