Division of Thoracic Surgery, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
Cancer Immunol Immunother. 2011 Dec;60(12):1721-8. doi: 10.1007/s00262-011-1073-8. Epub 2011 Jul 19.
This study aims to determine whether a semi-quantitative assessment of inflammatory response in tumor and stroma on routine hematoxylin and eosin-stained (H&E) slides can predict survival in patients with epithelioid malignant pleural mesothelioma (MPM). H&E sections of 175 epithelioid MPM specimens from a single institution (1989-2009) were reviewed. Patients who received neoadjuvant chemotherapy were excluded from analysis. Each tumor was histologically assessed for acute and chronic inflammatory response both within the tumor and the stromal component. Inflammatory response was graded: low (none to mild infiltrate) or high (moderate to severe infiltrate). Log-rank test and Cox proportional hazards regression were used to investigate the association between the degree of inflammation (acute/tumor, acute/stroma, chronic/tumor, and chronic/stroma) and overall survival (OS). Patients with high chronic inflammatory response in stroma (n = 59) had improved survival compared to low (n = 116) (median OS = 19.4 vs. 15.0 months, P = 0.01). This prognostic stratification remained significant in stage III patients (median OS = 16.0 vs. 9.3 months, P = 0.03). In multivariate analysis, chronic inflammation in stroma was an independent predictor of survival (HR = 0.659, 95% CI 0.464-0.937, P = 0.02). While high degree of chronic inflammatory cell infiltration in the stromal component was associated with improved overall survival, degree of other inflammatory responses did not show significant correlation with OS. Our study for the first time investigates inflammatory response in tumor and stroma and not only suggests the prognostic value of inflammatory response in epithelioid MPM but also provides rationale for investigation of immunotherapy to benefit epithelioid MPM patients.
这项研究旨在确定在常规苏木精和伊红（H&E）染色切片上对肿瘤和基质中的炎症反应进行半定量评估是否可以预测上皮样恶性胸膜间皮瘤（MPM）患者的生存。对来自单个机构（1989-2009 年）的 175 例上皮样 MPM 标本的 H&E 切片进行了回顾性分析。排除接受新辅助化疗的患者进行分析。每个肿瘤均在肿瘤内和基质成分中进行急性和慢性炎症反应的组织学评估。炎症反应分级：低（无或轻度浸润）或高（中度至重度浸润）。对数秩检验和 Cox 比例风险回归用于研究炎症程度（急性/肿瘤、急性/基质、慢性/肿瘤和慢性/基质）与总生存（OS）之间的关联。基质中高慢性炎症反应的患者（n=59）与低慢性炎症反应的患者（n=116）相比，生存时间更长（中位 OS=19.4 个月比 15.0 个月，P=0.01）。这种预后分层在 III 期患者中仍然具有统计学意义（中位 OS=16.0 个月比 9.3 个月，P=0.03）。多变量分析显示，基质中的慢性炎症是生存的独立预测因子（HR=0.659，95%CI 0.464-0.937，P=0.02）。虽然基质中慢性炎症细胞浸润程度高与总生存时间延长相关，但其他炎症反应程度与 OS 无显著相关性。我们的研究首次调查了肿瘤和基质中的炎症反应，不仅表明炎症反应在上皮样 MPM 中的预后价值，而且为研究免疫疗法使上皮样 MPM 患者受益提供了依据。
