Almangush Alhadi, Bello Ibrahim O, Heikkinen Ilkka, Hagström Jaana, Haglund Caj, Kowalski Luiz Paulo, Coletta Ricardo D, Mäkitie Antti A, Salo Tuula, Leivo Ilmo
Department of Pathology, University of Helsinki, 00014 Helsinki, Finland.
Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland.
Cancers (Basel). 2021 Jun 29;13(13):3235. doi: 10.3390/cancers13133235.
Although patients with early-stage oral tongue squamous cell carcinoma (OTSCC) show better survival than those with advanced disease, there is still a number of early-stage cases who will suffer from recurrence, cancer-related mortality and worse overall survival. Incorporation of an immune descriptive factor in the staging system can aid in improving risk assessment of early OTSCC. A total of 290 cases of early-stage OTSCC re-classified according to the American Joint Committee on Cancer (AJCC 8) staging were included in this study. Scores of tumor-infiltrating lymphocytes (TILs) were divided as low or high and incorporated in TNM AJCC 8 to form our proposed TNM-Immune system. Using AJCC 8, there were no significant differences in survival between T1 and T2 tumors ( 0.05). Our proposed TNM-Immune staging system allowed for significant discrimination in risk between tumors of T1N0M0-Immune vs. T2N0M0-Immune. The latter associated with a worse overall survival with hazard ratio (HR) of 2.87 (95% CI 1.92-4.28; < 0.001); HR of 2.41 (95% CI 1.26-4.60; 0.008) for disease-specific survival; and HR of 1.97 (95% CI 1.13-3.43; 0.017) for disease-free survival. The TNM-Immune staging system showed a powerful ability to identify cases with worse survival. The immune response is an important player which can be assessed by evaluating TILs, and it can be implemented in the staging criteria of early OTSCC. TNM-Immune staging forms a step towards a more personalized classification of early OTSCC.
尽管早期口腔舌鳞状细胞癌（OTSCC）患者的生存率高于晚期患者，但仍有一些早期病例会出现复发、癌症相关死亡以及较差的总生存率。在分期系统中纳入免疫描述因子有助于改善早期OTSCC的风险评估。本研究纳入了根据美国癌症联合委员会（AJCC第8版）分期重新分类的290例早期OTSCC病例。肿瘤浸润淋巴细胞（TILs）评分分为低或高，并纳入AJCC第8版TNM分期以形成我们提出的TNM-免疫分期系统。使用AJCC第8版，T1和T2肿瘤之间的生存率无显著差异（P>0.05）。我们提出的TNM-免疫分期系统能够显著区分T1N0M0-免疫与T2N0M0-免疫肿瘤之间的风险。后者与更差的总生存率相关，风险比（HR）为2.87（95%CI 1.92-4.28；P<0.001）；疾病特异性生存率的HR为2.41（95%CI 1.26-4.60；P=0.008）；无病生存率的HR为1.97（95%CI 1.13-3.43；P=0.017）。TNM-免疫分期系统显示出强大的识别生存率较差病例的能力。免疫反应是一个重要因素，可通过评估TILs进行评估，并可纳入早期OTSCC的分期标准。TNM-免疫分期朝着早期OTSCC更个性化的分类迈出了一步。
