Martin Benedikt, Märkl Bruno
Institute of Pathology, University Clinic Augsburg, Augsburg, Germany.
Visc Med. 2019 Mar;35(1):3-10. doi: 10.1159/000496565. Epub 2019 Feb 4.
Gastrointestinal (GI) cancers contribute significantly to the worldwide cancer burden. Pathologic evaluation is indispensable for the estimation of prognosis and therapeutic strategy. At present, immunotherapies are evolving into efficient therapeutic approaches, which are accompanied by the need for biomarkers to predict therapy response. In colorectal cancers, the only predictive biomarker for Food and Drug Administration-approved immunotherapy is the mismatch repair status. Besides, pathogenic mutations, tumor mutational burden, neoantigen load, and features of the immune contexture could soon find their way into clinical routine. Furthermore, in colorectal cancer, the Immunoscore, which is defined by the amount of CD3+ and CD8+ T-cells in the tumor center as well as at the infiltrative margin, might supplement the TNM system in the future (as TNM-Immune). This immunologic biomarker was shown to be impressively prognostic and predictive in colorectal cancer. In conclusion, there is increasing evidence of immunologic as well as predictive biomarkers for immunotherapies in GI cancers. Nevertheless, future progress is necessary for the variety of current advances to be implemented in clinical care.
胃肠道(GI)癌症在全球癌症负担中占相当大的比例。病理评估对于预后估计和治疗策略至关重要。目前,免疫疗法正在发展成为有效的治疗方法,这就需要生物标志物来预测治疗反应。在结直肠癌中,美国食品药品监督管理局批准的免疫疗法的唯一预测生物标志物是错配修复状态。此外,致病突变、肿瘤突变负荷、新抗原负荷和免疫微环境特征可能很快会应用于临床常规检测。此外,在结直肠癌中,由肿瘤中心以及浸润边缘的CD3+和CD8+ T细胞数量定义的免疫评分,未来可能会补充TNM系统(作为TNM-免疫)。这种免疫生物标志物在结直肠癌中显示出令人印象深刻的预后和预测价值。总之,越来越多的证据表明胃肠道癌症免疫疗法存在免疫和预测生物标志物。然而,要将目前的各种进展应用于临床护理,未来仍需取得进展。