Abstract
BackgroundThe Glasgow Microenvironment Score (GMS) combines peritumoural inflammation and tumour stroma percentage to assess interactions between tumour and microenvironment. This was previously demonstrated to associate with colorectal cancer (CRC) prognosis, and now requires validation and assessment of interactions with adjuvant therapy.MethodsTwo cohorts were utilised; 862 TNM I–III CRC validation cohort, and 2912 TNM II–III CRC adjuvant chemotherapy cohort (TransSCOT). Primary endpoints were disease-free survival (DFS) and relapse-free survival (RFS). Exploratory endpoint was adjuvant chemotherapy interaction.ResultsGMS independently associated with DFS (p = 0.001) and RFS (p < 0.001). GMS significantly stratified RFS for both low risk (GMS 0 v GMS 2: HR 3.24 95% CI 1.85–5.68, p < 0.001) and high-risk disease (GMS 0 v GMS 2: HR 2.18 95% CI 1.39–3.41, p = 0.001). In TransSCOT, chemotherapy type (pinteraction = 0.013), but not duration (p = 0.64) was dependent on GMS. Furthermore, GMS 0 significantly associated with improved DFS in patients receiving FOLFOX compared with CAPOX (HR 2.23 95% CI 1.19–4.16, p = 0.012).ConclusionsThis study validates the GMS as a prognostic tool for patients with stage I–III colorectal cancer, independent of TNM, with the ability to stratify both low- and high-risk disease. Furthermore, GMS 0 could be employed to identify a subset of patients that benefit from FOLFOX over CAPOX.
Highlights
Colorectal cancer (CRC) poses a significant burden on healthcare worldwide, with 1.8 million colorectal cancer (CRC)-related deaths in 20181
Glasgow Microenvironment Score (GMS) 0 could be employed to identify a subset of patients that benefit from
As the local inflammatory response is fundamental in orchestrating host anti-tumour immunity[7], an increase in infiltrating immune cell density is recognised as a stage-independent favourable prognostic characteristic[8, 9] and a recent study in colon cancer highlighted tumour immunity as pivotal to accurate assessment of recurrence risk in conjunction with TNM10
Summary
Colorectal cancer (CRC) poses a significant burden on healthcare worldwide, with 1.8 million CRC-related deaths in 20181. Two independent prognostic scoring systems assessing the tumour microenvironment have been developed, namely tumour stromal percentage (TSP) and an assessment of peritumoural inflammation, both of which remain optional in the current edition of the Royal College of Pathologists colorectal cancer reporting dataset[3]. The Glasgow Microenvironment Score (GMS) combines peritumoural inflammation and tumour stroma percentage to assess interactions between tumour and microenvironment. This was previously demonstrated to associate with colorectal cancer (CRC) prognosis, it requires validation and assessment of interactions with adjuvant therapy
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