Abstract Purpose: Previous studies have shown thymic stromal lymphopoietin (TSLP) to be an important driver of type 2 inflammation. A new and unexpected function for TSLP has been found in the induction and progression of a variety of tumors. This study conducted TSLP performance in lung cancer patients and the correlation of the clinical pathological data. Materials and Methods: The patients with pathological diagnosis of lung cancer were enrolled. The percentage of CD19 + B cells was determined in the lymphocyte gate and counted via flow cytometry. Relevant serum cytokines including TSLP were analyzed using LEGENDplex software. In vitro study was conducted by A549 cell line and the mRNA expression change of TSLP was extracted by Reverse Transcriptase PCR (RT-PCR). Results: When comparing the frequencies of B cell subsets between early-stage (N = 31) and late-stage lung cancer group (N = 29), the frequency of memory B cell (17.3±6.1% vs 23.4±15.1%, p=0.042), CD27+IgM+ B cell (1.8±1.3% vs 2.9±2.3%, p=0.030), class-switched B cell (15.5±5.5% vs 22.2±14.9%, p=0.023), class-switched memory B cell (69.9±11.3% vs 59.9±19.7%, p=0.017) and plasmablast (8.5±7.3% vs 18.0±20.8%, p=0.019) were significantly different between groups. The patients with higher frequency of class-switched B cell had significantly worse prognosis than low frequency (HR 3.054, 95% CI 1.007-9.262, p=0.049). The level of IL-1B, IL-6, IL-10, IL-12, IL-13, and TSLP were significantly higher in the late-stage cancer patients. Simulation in vitro test with human lung A549 cell line was performed, the expression of short-form TSLP (sfTSLP) level decreased with the higher anti-cancer drug as Pemetrexed concentration. Conclusions: The increase proportion of CD27+CD38- (class-switched) B cell could be an independent, poor prognostic factor for NSCLC patients. TSLP signaling is addressed to the anti-cancer therapeutic response. Therefore, TSLP and relevant cytokines may be involved directly and indirectly in shaping the inflammatory status of the tumor microenvironment. Citation Format: Chung-Yu Chen, Ying-Yin Chen, Hung-Chueh Peng, Yi-Ling Ye. The expression and immune regulation of thymic stromal lymphopoietin in non-small cell lung cancer development and progression. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4449.