Immune Status is Prognostic for Poor Survival in Colorectal Cancer

Dawn O'Shea

July 24, 2020

A study by researchers in Northern Ireland, Scotland, and England indicates a significant relationship between tumour hypoxia, the immune response, and prognosis in colorectal cancer (CRC).

The study, published in the journal Cellular and Molecular Biology, evaluated overall survival in CRC by immune (CD3, CD4, CD8, CD20, and FOXP3) and immune-checkpoint (ICOS, IDO-1, and PD-L1) biomarkers.

The research revealed that determining immune-cold tumours by combined low-density cell counts of CD3, CD4 and CD8 immunohistochemistry was the best prognosticator across stage II-IV colorectal cancer (CRC), particularly in patients with stage IV disease (HR 1.98; 95% CI 1.47-2.67).

These immune-cold CRCs were associated with tumour hypoxia, confirmed using CAIX immunohistochemistry (P=0.0009).

The authors said this may mediate disease progression through common biology (KRAS mutations, CRIS-B subtype, and SPP1 mRNA overexpression).

“Given the significantly poorer survival of immune-cold CRC patients, these data illustrate that assessment of CD4-expressing cells complements low CD3 and CD8 immunohistochemical quantification in the tumour bulk, potentially facilitating immunophenotyping of patient biopsies to predict prognosis. In addition, we found immune-cold CRCs to associate with a difficult-to-treat, poor prognosis hypoxia signature, indicating that these patients may benefit from hypoxia-targeting clinical trials,” the authors concluded.

Craig SG, Humphries MP, Alderdice M, Bingham V, Richman SD, Loughrey MB, Coleman HG, Viratham-Pulsawatdi A, McCombe K, Murray GI, Blake A, Domingo E, Robineau J, Brown L, Fisher D, Seymour MT, Quirke P, Bankhead P, McQuaid S, Lawler M, McArt DG, Maughan TS, James JA, Salto-Tellez M. Immune status is prognostic for poor survival in colorectal cancer patients and is associated with tumour hypoxia. Br J Cancer. 2020 Jul 20 [Epub ahead of print]. doi: 10.1038/s41416-020-0985-5. PMID: 32684627 View abstract. 

This article originally appeared on Univadis, part of the Medscape Professional Network.


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