Institute of Pathology, University Hospital Cologne, Cologne, Germany.
Department of General, Visceral, Cancer and Transplantation Surgery, University Hospital Cologne, Cologne, Germany.
Cancer Immunol Immunother. 2020 Apr;69(4):523-533. doi: 10.1007/s00262-019-02475-w. Epub 2020 Jan 20.
The outcome in esophageal adenocarcinoma (EAC) is still poor with only 20% of patients in Western populations surviving for more than 5 years. Almost nothing is known about the precise composition of immune cells and their gene expression profiles in primary resected EACs and also nothing compared to neoadjuvant treated EACs. This study analyzes and compares immune profiles of primary resected and neoadjuvant treated esophageal adenocarcinoma and unravels possible targets for immunotherapy. We analyzed 47 EAC in total considering a set of 30 primary treatment-naive EACs and 17 neoadjuvant pretreated (12 × CROSS, 5 × FLOT) using the Nanostring's panel-based gene expression platform including 770 genes being important in malignant tumors and their immune micromileu. Most of the significantly altered genes are involved in the regulation of immune responses, T-and B cell functions as well as antigen processing. Chemokine-receptor axes like the CXCL9, -10,-11/CXCR3- are prominent in esophageal adenocarcinoma with a fold change of up to 9.5 promoting cancer cell proliferation and metastasis. ARG1, as a regulator of T-cell fate is sixfold down-regulated in untreated primary esophageal tumors. The influence of the currently used neoadjuvant treatment revealed a down-regulation of nearly all important checkpoint markers and inflammatory related genes in the local microenvironment. We found a higher expression of checkpoint markers like LAG3, TIM3, CTLA4 and CD276 in comparison to PD-L1/PD-1 supporting clinical trials analyzing the efficacy of a combination of different checkpoint inhibitors in EACs. We found an up-regulation of CD38 or LILRB1 as examples of additional immune escape mechanism.
食管腺癌(EAC)的预后仍然很差,只有 20%的西方人群患者存活时间超过 5 年。对于原发性切除的 EAC 中免疫细胞的精确组成及其基因表达谱,几乎一无所知,与新辅助治疗的 EAC 相比也是如此。本研究分析和比较了原发性切除和新辅助治疗的食管腺癌的免疫谱,并揭示了免疫治疗的可能靶点。我们总共分析了 47 例 EAC,考虑了一组 30 例原发性治疗初治的 EAC 和 17 例新辅助预处理的 EAC(12×CROSS,5×FLOT),使用 Nanostring 的基于面板的基因表达平台,包括 770 个在恶性肿瘤及其免疫微环境中重要的基因。大多数显著改变的基因参与免疫反应、T 和 B 细胞功能以及抗原处理的调节。趋化因子受体轴,如 CXCL9、-10、-11/CXCR3-,在食管腺癌中很突出,其倍数变化高达 9.5,促进癌细胞增殖和转移。ARG1 作为 T 细胞命运的调节剂,在未经治疗的原发性食管肿瘤中下调了六倍。目前新辅助治疗的影响导致局部微环境中几乎所有重要的检查点标志物和炎症相关基因的下调。与 PD-L1/PD-1 相比,我们发现检查点标志物如 LAG3、TIM3、CTLA4 和 CD276 的表达更高,支持在 EAC 中分析不同检查点抑制剂联合治疗疗效的临床试验。我们发现 CD38 或 LILRB1 的上调,例如额外的免疫逃逸机制的例子。