Abstract
The tumor immune infiltrate, as recently evaluated with the immunoscore methodology, has been reported to be related to colorectal cancer (CRC) progression. Nevertheless, results varied from different studies. A meta‐analysis was conducted to solve this problem. We collected data from included studies to evaluate the prognostic role of immunoscore in CRC patients on overall survival (OS) and disease‐free survival (DFS). MEDLINE, EMBASE, and Cochrane libraries were searched through 30 June 2018. Hazard ratio (HR) with 95% confidence intervals (95% CI) was pooled using a random‐effects model for OS and a fixed‐effects model for DFS. Finally, eight studies (involving 4689 CRC cases) were identified as eligible publications. The results of the meta‐analysis showed that low immunoscore was significantly correlated with poor OS (HR = 1.74, 95% CI: 1.43‐2.13) and DFS (HR = 1.82, 95% CI: 1.64‐2.03). The findings from most subgroup analyses were consistent with those from the overall analysis. The immunoscore could be a useful prognostic marker in patients with CRC. It is necessary to evaluate immunological markers in international multicenter studies.
Highlights
Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide, with an estimated 1 849 518 new cases in 2018, and the second most common cause of death among cancer with an estimated 880 792 deaths.[1]The American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) system, based on the tumor‐node‐metastases (TNM) classification, has been widely used for staging CRC patients
The associations of immunoscore and overall survival (OS) in CRC patients did not differ by number of patients, max follow‐up, clinical stage, and Hazard ratio (HR) When cancer cases stratified by geographic region, the low immunoscore was significantly correlated with poor OS (HR = 1.81, 95% confidence intervals (95% CI): 1.39‐2.37) for Europeans, but not significantly correlated with Asians (HR = 1.46, 95% CI: 0.93‐2.29)
When cancer cases stratified by clinical stage, the low immunoscore was significantly correlated with poor disease‐free survival (DFS) for I‐III stage patients (HR = 3.61, 95% CI: 1.75‐7.44), which had a similar effect for all‐stage patients
Summary
Colorectal cancer (CRC) is the third most common cancer in men and the second most common cancer in women worldwide, with an estimated 1 849 518 new cases in 2018, and the second most common cause of death among cancer with an estimated 880 792 deaths.[1]. The system is of much importance but gives limited information for the prognostic benefit of the selected therapy.[2,3] Other markers for survival are needed.[2] Recent studies revealed that tumor‐infiltrating lymphocytes (TILs) play an important role in increasing the anti‐tumor immunity against CRC4,5 and other malignancies.[6,7,8,9,10] TILs show heterogeneity at its target sites,[5] just like other components in the tumor microenvironment. We conducted the meta‐analysis to assess the effects of immunoscore on overall survival (OS) and disease‐ free survival (DFS) in CRC patients
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