Division of Oncology, Department of Medicine, Mayo Clinic, Rochester, MN.
Alliance Statistics and Data Center, Rochester, MN.
JCO Precis Oncol. 2022 Aug;6:e2200010. doi: 10.1200/PO.22.00010.
The recommended duration of adjuvant fluoropyrimidine and oxaliplatin chemotherapy for patients with stage III colon cancer is based on tumor classification into clinically low-risk (T N) and high-risk (T or N) groups. We determined whether Immunoscore can enhance prognostication within these risk groups.
Patients with stage III colon carcinomas (N = 600) were randomly selected from the infusional fluorouracil, leucovorin, and oxaliplatin arm of adjuvant trial NCCTG N0147 (Alliance for Clinical Trials in Oncology). Tumors were evaluated for Immunoscore that quantifies CD3 and CD8 T-cell densities in the tumor center and invasive margin by digital image analysis. Disease-free survival (DFS) by Immunoscore was analyzed using a multivariable Cox regression model in each risk group with adjustment for covariates including , , and mismatch repair status.
Of 559 cancers with Immunoscore data, 299 (53.5%) were classified as clinically low-risk (T N) and 260 (46.5%) as clinically high-risk (T and/or N). Among patients with low-risk tumors, those with Immunoscore-Low versus Immunoscore-High tumors had significantly worse 5-year DFS rates (77.5% 91.8%; hazard ratio, 1.70; 95% CI, 1.03 to 2.79; = .037). Among patients with high-risk tumors, those with Immunoscore-Low versus Immunoscore-High tumors also had significantly worse DFS (55.3% 70.3%; hazard ratio, 1.65; 95% CI, 1.11 to 2.47; = .013). Tumors that were low-risk/Immunoscore-Low had similar outcomes as did tumors that were high-risk/Immunoscore-High ( = .174). Prognostication was significantly improved in multivariable models where Immunoscore was added to clinical risk parameters and limited biomarkers (likelihood ratio test = .0003).
Immunoscore can refine patient prognosis beyond clinical risk group classification, suggesting its potential utility for adjuvant decision making.
辅助氟嘧啶和奥沙利铂化疗用于 III 期结肠癌患者的推荐持续时间基于肿瘤分为临床低危（T N）和高危（T 或 N）组。我们确定免疫评分是否可以增强这些风险组的预后判断。
从辅助试验 NCCTG N0147（肿瘤临床试验联盟）的输注氟尿嘧啶、亚叶酸和奥沙利铂臂中随机选择 III 期结肠癌患者（N = 600）。通过数字图像分析评估肿瘤的免疫评分，该评分定量评估肿瘤中心和浸润边缘的 CD3 和 CD8 T 细胞密度。使用多变量 Cox 回归模型分析每个风险组的无病生存期（DFS），并根据协变量（包括肿瘤分级、T 分期和错配修复状态）进行调整。
在具有免疫评分数据的 559 例癌症中，299 例（53.5%）被归类为临床低危（T N），260 例（46.5%）为临床高危（T 和/或 N）。在低危肿瘤患者中，免疫评分低与免疫评分高的患者 5 年 DFS 率显著降低（77.5% 91.8%；危险比，1.70；95%CI，1.03 至 2.79； =.037）。在高危肿瘤患者中，免疫评分低与免疫评分高的患者的 DFS 也显著降低（55.3% 70.3%；危险比，1.65；95%CI，1.11 至 2.47； =.013）。低危/免疫评分低的肿瘤与高危/免疫评分高的肿瘤具有相似的结果（ =.174）。在将免疫评分添加到临床风险参数和有限的生物标志物的多变量模型中，预后显著改善（似然比检验 =.0003）。
免疫评分可以改善患者预后，超越临床风险组分类，提示其在辅助决策中的潜在应用。
