Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
University of Melbourne, Parkville, Victoria, Australia.
Dis Colon Rectum. 2019 Apr;62(4):498-508. doi: 10.1097/DCR.0000000000001332.
There is increasing literature emerging on the significance of tumor-infiltrating lymphocytes in colorectal cancer. However, there have been inconsistent findings, secondary to small patient numbers and varied methods for identifying these lymphocytes.
The aim of this study was to determine the prognostic and predictive power of tumor-infiltrating lymphocytes in colon, rectal (in neoadjuvant setting), and metastatic colorectal cancer.
A comprehensive search of PubMed and Embase was undertaken from January 2006 to December 2016.
The inclusion criteria included a description of the tumor-infiltrating lymphocyte subset(s) assessed with reporting of associated short- and long-term outcomes.
The main outcome measures, were disease-free and overall survival.
A total of 25 studies were included, 15 for primary colorectal cancer (4719 patients), 7 for locally advanced rectal cancer (727 patients), and 3 studies for metastatic colorectal cancer (418 patients). High CD3, CD8, FoxP3, and CD45RO densities were associated with improved overall survival for primary colorectal cancer, with pooled estimated HRs of 0.88, 0.81, 0.70, and 0.63 (all p < 0.001) respectively. Furthermore, in locally advanced rectal cancer, the levels of CD8 cells were a significant predictor of good tumor regression grade after chemoradiotherapy.
The retrospective nature of included studies and the significant interstudy heterogeneity were limitations.
There is increasing evidence that tumor-infiltrating lymphocytes play an important role in predicting prognosis in colorectal cancer and tumor regression after neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Clinical researchers are now in a unique position to build on this work to identify robust predictive markers to stratify patients not only to currently available therapies but also to immunotherapy, which has demonstrated success in improving patient outcomes.
越来越多的文献表明肿瘤浸润淋巴细胞在结直肠癌中的意义。然而，由于患者数量少且识别这些淋巴细胞的方法不同，研究结果并不一致。
本研究旨在确定肿瘤浸润淋巴细胞在结肠癌、直肠癌（新辅助治疗环境下）和转移性结直肠癌中的预后和预测能力。
对 2006 年 1 月至 2016 年 12 月的 PubMed 和 Embase 进行了全面检索。
纳入标准包括描述评估的肿瘤浸润淋巴细胞亚群，并报告相关的短期和长期结果。
主要观察指标为无病生存率和总生存率。
共纳入 25 项研究，其中 15 项为原发性结直肠癌（4719 例患者），7 项为局部进展期直肠癌（727 例），3 项为转移性结直肠癌（418 例）。CD3、CD8、FoxP3 和 CD45RO 高密度与原发性结直肠癌的总生存率提高相关，合并估计 HR 分别为 0.88、0.81、0.70 和 0.63（均 P <0.001）。此外，在局部进展期直肠癌中，CD8 细胞水平是放化疗后肿瘤消退良好的显著预测因子。
纳入研究的回顾性性质和显著的异质性是其局限性。
越来越多的证据表明，肿瘤浸润淋巴细胞在预测结直肠癌的预后和局部进展期直肠癌新辅助放化疗后的肿瘤消退方面发挥着重要作用。临床研究人员现在处于独特的位置，可以在此基础上进一步确定强大的预测标志物，不仅可以对目前的治疗方法进行分层，还可以对免疫治疗进行分层，免疫治疗已被证明能改善患者的预后。
