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New Immune-Based Classification for Predicting Colorectal Cancer Survival

By: Andrew Goldstein
Posted: Thursday, July 26, 2018

By quantifying specific T-cell subsets in certain tumor regions for patients with resectable colorectal cancer, Franck Pagès, MD, PhD, of the European Hospital, Paris, France, and colleagues have developed a standardized immune-based assay for classification of patients with colon cancer. According to their study findings, published in The Lancet, this score seemed to outperform existing prognostic tumor parameters.

“The consensus Immunoscore study represents the largest international consortium validating a standardised immune parameter to stratify patients with cancer,” the investigators stated. “These results support the implementation of the consensus Immunoscore as a new component for a TNM-Immune classification of cancer.”

Dr. Pagès and colleagues focused on tissue samples from 2,681 patients with TNM stages I to III colon cancer. Of them, 700 patients were part of the training set, 636 patients were in the internal validation set, and the remaining 1,345 patients were part of the external validation set. They used dedicated image-analysis software to quantify the density of CD3-positive and CD8-positive T-cell effectors in the tumor and invasive margin.

For the Immunoscore analysis, a density of 0% to 25% was scored as low, a density between 25% and 70% was scored as intermediate, and a density of 70% or above was scored as high. In all three cohorts, patients with high Immunoscores had significantly higher overall survival, disease-free survival, and prolonged time to recurrence than those in the cohorts of intermediate or low Immunoscores, independent of other factors.

Additionally, to compare the prognostic performance of the Immunoscore and visual assessment of the density of tumor-infiltrating T cells in tumor tissue stained with hematoxylin and eosin, 11 observers reviewed 268 representative cases. An 88% concordance among observers was reported for the Immunoscore, compared with a total absence of concordance in 45% of cases.

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