Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach
Background: Completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) comprises a heterogeneous population according to discrepancies in survival prognosis. Accumulating evidence suggests that tumor-infiltrating lymphocytes (TILs) are clinically significant, despite a lack of consensus r...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-01-01
|
| Series: | Therapeutic Advances in Medical Oncology |
| Online Access: | https://doi.org/10.1177/1758835920984975 |
| _version_ | 1829532953257967616 |
|---|---|
| author | Wen Feng Yuan Li Lei Shen Qin Zhang Xu-Wei Cai Zheng-Fei Zhu Meng-Hong Sun Hai-Quan Chen Xiao-Long Fu |
| author_facet | Wen Feng Yuan Li Lei Shen Qin Zhang Xu-Wei Cai Zheng-Fei Zhu Meng-Hong Sun Hai-Quan Chen Xiao-Long Fu |
| author_sort | Wen Feng |
| collection | DOAJ |
| description | Background: Completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) comprises a heterogeneous population according to discrepancies in survival prognosis. Accumulating evidence suggests that tumor-infiltrating lymphocytes (TILs) are clinically significant, despite a lack of consensus regarding the immunological score (IS) in NSCLC. Here, we determined the prognostic value of the immune microenvironment as an IS in a uniform cohort of patients with completely resected stage IIIA(N2) NSCLC. Methods: Consecutive patients with pathologically confirmed stage IIIA(N2) NSCLC and who underwent complete resection (2005–2012) were retrospectively reviewed. Tissue microarrays (TMAs) were constructed from surgical paraffin-embedded primary lung tumor specimen. For each case, two representative regions from the tumor center (CT) and two from the invasive margin (IM) containing the highest density of lymphocytes were selected. Densities of CD3+, CD45RO+, and CD8+ lymphocytes were assessed using immunohistochemistry (IHC) by specialized pathologists according to predefined scoring scales. Patients were classified according to IS definition based on TIL type, density, and distribution, and relationships between IS and prognosis were evaluated. Results: Patients ( N = 288) with complete IHC-based TMA spots were included. Univariate analyses showed that CD3+ T cell density was associated with neither overall survival (OS) nor distant metastasis-free survival (DMFS), whereas CD45RO+ T cell density in the IM was a significant prognostic factor for DMFS ( p = 0.02) and was predictive of OS ( p = 0.05). Combined CD45RO+ and CD8+ cell infiltration in tumor regions (CT and IM) significantly improved IS prognostic impact. Multivariate analyses revealed IS as an independent prognostic predictor for both DMFS ( p = 0.001) and OS ( p = 0.002). Conclusion: The proposed IS might provide valuable prognostic information, including prediction of DMFS and OS in stage IIIA(N2) NSCLC patients. Larger patient cohorts are needed to validate this IS classification, which might assist with accurate risk stratification and treatment decisions. |
| first_indexed | 2024-12-16T18:48:48Z |
| format | Article |
| id | doaj.art-48e49195609d4024970eba807d146f08 |
| institution | Directory Open Access Journal |
| issn | 1758-8359 |
| language | English |
| last_indexed | 2024-12-16T18:48:48Z |
| publishDate | 2021-01-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Therapeutic Advances in Medical Oncology |
| spelling | doaj.art-48e49195609d4024970eba807d146f082022-12-21T22:20:45ZengSAGE PublishingTherapeutic Advances in Medical Oncology1758-83592021-01-011310.1177/1758835920984975Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approachWen FengYuan LiLei ShenQin ZhangXu-Wei CaiZheng-Fei ZhuMeng-Hong SunHai-Quan ChenXiao-Long FuBackground: Completely resected stage IIIA(N2) non-small cell lung cancer (NSCLC) comprises a heterogeneous population according to discrepancies in survival prognosis. Accumulating evidence suggests that tumor-infiltrating lymphocytes (TILs) are clinically significant, despite a lack of consensus regarding the immunological score (IS) in NSCLC. Here, we determined the prognostic value of the immune microenvironment as an IS in a uniform cohort of patients with completely resected stage IIIA(N2) NSCLC. Methods: Consecutive patients with pathologically confirmed stage IIIA(N2) NSCLC and who underwent complete resection (2005–2012) were retrospectively reviewed. Tissue microarrays (TMAs) were constructed from surgical paraffin-embedded primary lung tumor specimen. For each case, two representative regions from the tumor center (CT) and two from the invasive margin (IM) containing the highest density of lymphocytes were selected. Densities of CD3+, CD45RO+, and CD8+ lymphocytes were assessed using immunohistochemistry (IHC) by specialized pathologists according to predefined scoring scales. Patients were classified according to IS definition based on TIL type, density, and distribution, and relationships between IS and prognosis were evaluated. Results: Patients ( N = 288) with complete IHC-based TMA spots were included. Univariate analyses showed that CD3+ T cell density was associated with neither overall survival (OS) nor distant metastasis-free survival (DMFS), whereas CD45RO+ T cell density in the IM was a significant prognostic factor for DMFS ( p = 0.02) and was predictive of OS ( p = 0.05). Combined CD45RO+ and CD8+ cell infiltration in tumor regions (CT and IM) significantly improved IS prognostic impact. Multivariate analyses revealed IS as an independent prognostic predictor for both DMFS ( p = 0.001) and OS ( p = 0.002). Conclusion: The proposed IS might provide valuable prognostic information, including prediction of DMFS and OS in stage IIIA(N2) NSCLC patients. Larger patient cohorts are needed to validate this IS classification, which might assist with accurate risk stratification and treatment decisions.https://doi.org/10.1177/1758835920984975 |
| spellingShingle | Wen Feng Yuan Li Lei Shen Qin Zhang Xu-Wei Cai Zheng-Fei Zhu Meng-Hong Sun Hai-Quan Chen Xiao-Long Fu Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach Therapeutic Advances in Medical Oncology |
| title | Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach |
| title_full | Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach |
| title_fullStr | Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach |
| title_full_unstemmed | Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach |
| title_short | Clinical impact of the tumor immune microenvironment in completely resected stage IIIA(N2) non-small cell lung cancer based on an immunological score approach |
| title_sort | clinical impact of the tumor immune microenvironment in completely resected stage iiia n2 non small cell lung cancer based on an immunological score approach |
| url | https://doi.org/10.1177/1758835920984975 |
| work_keys_str_mv | AT wenfeng clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT yuanli clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT leishen clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT qinzhang clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT xuweicai clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT zhengfeizhu clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT menghongsun clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT haiquanchen clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach AT xiaolongfu clinicalimpactofthetumorimmunemicroenvironmentincompletelyresectedstageiiian2nonsmallcelllungcancerbasedonanimmunologicalscoreapproach |