IMMUNOSCORE AS A PREDICTOR OF RECURRENCE IN STAGE III COLON CANCER

Keywords:

immunoscore - cancer de colon - adjuvante

Introduction: Immune cell infiltration in the tumor has been associated with favorable outcomes in several malignancies. In colon cancer, the ImmunoScore (IS) test measures CD3+ and CD8+ T-cells infiltration in the center and margins of the tumor, providing a score that goes from low to high immune cell density. Those with higher immune cell densities are classified as having a low risk of relapse. We aimed to evaluate the prognostic role of the IS test in stage II–III colon cancer in a real-world scenario. Methods: Tumor samples from 50 patients (pts) with stage II-III colon cancer submitted to oncologic surgery from April 2017 to January 2021 were evaluated with the IS test. The primary endpoint was the association between the IS test with disease recurrence. Fisher's exact test was used to compare categorical variables. Survival estimates were provided by the Kaplan-Meier method. Prognostic variables were analyzed using Cox regression. Results: Forty-nine pts were evaluable; the test provided an invalid result for one patient. The median age was 66 years (range 29 – 95). Twenty pts (40%) had stage II and 29 (59%) stage III colon cancer; respectively 40% and 86% of these pts received adjuvant chemotherapy. A high-risk IS was detected in 24 pts (49%), while 25 (51%) had low risk. The IS risk did not differ according to the stage (P=0.556). After a median follow-up of 37 months, 7 pts had a recurrence; 5 were in the high-risk IS group, and two were in the low-risk IS group (P=0.247). All the recurrences occurred in pts who had stage III disease at diagnosis. In the stage III group, multivariable analysis showed that high-risk IS was associated with a trend towards an increased risk of recurrence (HR 6.09, 95% CI 0.97 – 38.21, P=0.054), while receiving adjuvant chemotherapy notably decreased the risk (HR 0.08, 95% CI 0.01 – 0.47, P=0.005). Among stage III diseases, the 3-year recurrence-free survival was 61.5% (95% CI 30.8 – 81.8%) in the high-risk IS group and 85.5% (95% CI 53.2 – 96.2) in the low-risk IS group. Conclusions: The IS test identified pts with stage III colon cancer with a higher risk of recurrence, confirming its prognostic role. The use of IS to predict chemotherapy benefits and define treatment escalation and de-escalation strategies warrants further prospective studies. An ongoing prospective study coordinated by our group will provide additional information about the test.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 November 2022