School of Medicine, University of Glasgow, Glasgow, United Kingdom.
School of Medicine, University of Glasgow, Glasgow, United Kingdom.
Cancer Treat Rev. 2020 Feb;83:101949. doi: 10.1016/j.ctrv.2019.101949. Epub 2019 Dec 11.
The host anti-tumour inflammatory response is a strong prognostic indicator, and tumour infiltrating lymphocytes (TILs) are believed to have a complimentary role alongside TNM assessment in dictating future management. However, there is wide disagreement regarding the most efficacious and cost-effective method of assessment.
A comprehensive literature search was performed of EMBASE, MedLine and PubMed as well as an assessment of references to identify all relevant studies relating to the assessment of the peri-tumoural inflammatory response or TILs and prognosis in colorectal cancer (CRC). A meta-analysis was performed of 67 studies meeting the REMARK criteria using RevMan software.
Intratumoural assessment of both CD3 and CD8 in CRC were significant for disease-free survival (DFS) (combined HRs 0.46; 95%CI: 0.39-0.54 and 0.54; 95%CI: 0.45-0.65), as well as overall survival (OS) and disease-specific survival (DSS). The same was true for assessment of CD3 and CD8 at the invasive margin (DFS: combined HRs 0.45; 95%CI: 0.33-0.61 and 0.51; 95%CI: 0.41-0.62). However, similar fixed effects summaries were also observed for H&E-based methods, like Klintrup-Makinen grade (DFS: HR 0.62; 95%CI: 0.43-0.88). Furthermore, inflammatory assessments were independent of MSI status.
The evidence suggests that it is the density of a co-ordinated local inflammatory infiltrate that confers survival benefit, rather than any individual immune cell subtype. Furthermore, the location of individual cells within the tumour microenvironment does not appear to influence survival. The authors advocate a standardised assessment of the local inflammatory response, but caution against emphasizing the importance of any individual immune cell subtype.
宿主抗肿瘤炎症反应是一个强有力的预后指标，肿瘤浸润淋巴细胞（TILs）被认为与 TNM 评估一起在决定未来治疗方面具有互补作用。然而，对于最有效和最具成本效益的评估方法存在广泛的分歧。
对 EMBASE、MedLine 和 PubMed 进行了全面的文献检索，并对参考文献进行了评估，以确定所有与评估结直肠癌（CRC）周围炎症反应或 TILs 与预后相关的相关研究。使用 RevMan 软件对符合 REMARK 标准的 67 项研究进行了荟萃分析。
CRC 中肿瘤内 CD3 和 CD8 的评估对无病生存（DFS）（合并 HRs 0.46；95%CI：0.39-0.54 和 0.54；95%CI：0.45-0.65）以及总生存（OS）和疾病特异性生存（DSS）均有显著意义。在侵袭边缘评估 CD3 和 CD8 也是如此（DFS：合并 HRs 0.45；95%CI：0.33-0.61 和 0.51；95%CI：0.41-0.62）。然而，类似的固定效应总结也观察到了基于 H&E 的方法，如 Klintrup-Makinen 分级（DFS：HR 0.62；95%CI：0.43-0.88）。此外，炎症评估与 MSI 状态无关。
证据表明，赋予生存益处的是协调局部炎症浸润的密度，而不是任何单个免疫细胞亚型。此外，肿瘤微环境中单个细胞的位置似乎并不影响生存。作者主张对局部炎症反应进行标准化评估，但谨慎强调任何单个免疫细胞亚型的重要性。
