Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece.
World J Gastroenterol. 2024 Feb 28;30(8):794-798. doi: 10.3748/wjg.v30.i8.794.
In this editorial we comment on the article published "Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment". Small bowel adenocarcinoma (SBA) is a rare gastrointestinal neoplasm and despite the small intestine's significant surface area, SBA accounts for less than 3% of such tumors. Early detection is challenging and the reason arises from its asymptomatic nature, often leading to late-stage discovery and poor prognosis. Treatment involves platinum-based chemotherapy with a 5-fluorouracil combination, but the lack of effective chemotherapy contributes to a generally poor prognosis. SBAs are linked to genetic disorders and risk factors, including chronic inflammatory conditions. The unique characteristics of the small bowel, such as rapid cell renewal and an active immune system, contributes to the rarity of these tumors as well as the high intratumoral infiltration of immune cells is associated with a favorable prognosis. Programmed cell death-ligand 1 (PD-L1) expression varies across different cancers, with potential discrepancies in its prognostic value. Microsatellite instability (MSI) in SBA is associated with a high tumor mutational burden, affecting the prognosis and response to immunotherapy. The presence of PD-L1 and programmed cell death 1, along with tumor-infiltrating lymphocytes, plays a crucial role in the complex microenvironment of SBA and contributes to a more favorable prognosis, especially in the context of high MSI tumors. Stromal tumor-infiltrating lymphocytes are identified as independent prognostic indicators and the association between MSI status and a favorable prognosis, emphasizes the importance of evaluating the immune status of tumors for treatment decisions.
在这篇社论中，我们对发表的“程序性细胞死亡配体在小肠腺癌中的表达的临床意义取决于肿瘤微环境”一文进行了评论。小肠腺癌（SBA）是一种罕见的胃肠道肿瘤，尽管小肠的表面积很大，但 SBA 占此类肿瘤的比例不到 3%。早期检测具有挑战性，原因是其无症状性质，通常导致晚期发现和预后不良。治疗涉及基于铂的化疗与氟尿嘧啶联合，但缺乏有效的化疗导致普遍预后不良。SBAs 与遗传疾病和风险因素有关，包括慢性炎症性疾病。小肠的独特特征，如快速细胞更新和活跃的免疫系统，导致这些肿瘤罕见，并且肿瘤内免疫细胞的高浸润与有利的预后相关。程序性细胞死亡配体 1（PD-L1）在不同癌症中的表达不同，其预后价值可能存在差异。SBA 中的微卫星不稳定性（MSI）与高肿瘤突变负担相关，影响预后和对免疫治疗的反应。PD-L1 和程序性细胞死亡 1 的存在以及肿瘤浸润淋巴细胞在 SBA 的复杂微环境中起着至关重要的作用，特别是在高 MSI 肿瘤的情况下，与更有利的预后相关。基质肿瘤浸润淋巴细胞被确定为独立的预后指标，MSI 状态与有利预后之间的关联强调了评估肿瘤免疫状态对治疗决策的重要性。
