Department of Radiology, Sapporo Medical University School of Medicine, S1 W16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Med Mol Morphol. 2021 Sep;54(3):245-252. doi: 10.1007/s00795-021-00290-w. Epub 2021 May 8.
To supplement clinical decision-making in the management of cervical cancer, various prognostic factors, including tumor immune microenvironments, were examined in patients with cervical cancer treated with definitive chemoradiotherapy. We retrospectively analyzed the expression of CD8, FoxP3, HLA-1, PD-L1, and XRCC4 in 100 cases of cervical cancer. The observed tumor immune microenvironments were also classified into three types: inflamed, excluded, and cold type. Less FoxP3+ T cells and cold-type tumor were found to be poor prognostic factors in addition to non-SCC, large pre-treatment tumor volume, and three or less cycles of concurrent chemotherapy based on multivariate analysis. Cold-type tumors had significantly worse prognoses than the other two types, whereas inflamed- and excluded-type tumors showed similar 5-year disease-specific survival (P < 0.001; 0% vs. 60.3% vs. 72.3%). Radiotherapy could overcome the inhibitory immune microenvironment that occurs in excluded type. Individualized combination therapy adapted to pre-treatment tumor immunity may be necessary to improve radiotherapy outcomes in cervical cancer.
为了补充宫颈癌管理中临床决策的依据，我们在接受根治性放化疗的宫颈癌患者中检查了各种预后因素，包括肿瘤免疫微环境。我们回顾性分析了 100 例宫颈癌中 CD8、FoxP3、HLA-1、PD-L1 和 XRCC4 的表达。观察到的肿瘤免疫微环境也分为三种类型：炎症型、排除型和冷型。多因素分析发现，除了非 SCC、治疗前肿瘤体积大以及少于 3 个周期的同期化疗外，FoxP3+T 细胞较少和冷型肿瘤也是不良预后因素。冷型肿瘤的预后明显差于其他两种类型，而炎症型和排除型肿瘤的 5 年疾病特异性生存率相似（P<0.001；0% vs. 60.3% vs. 72.3%）。放疗可以克服排除型中发生的抑制性免疫微环境。可能需要针对治疗前肿瘤免疫的个体化联合治疗来改善宫颈癌的放疗效果。
