Abstract
Simple SummaryOsteosarcoma (OST) is the most common type of high-grade primary bone tumor, which mainly affects young adults. Despite the efforts that have been made to address the importance of immune-related factors in OST, there is still a lot to understand. The purpose of the current study was to evaluate the tumor-infiltrating lymphocytes (TIL), the expression of proteins involved in tumor biology, and their impact on the clinical outcome of OST patients. Our results suggest that the presence of tumor-infiltrating CD4+ cells provides protection to patients, and that CD8+ cells have a significant impact on the patient’s overall survival (OS) and progression-free survival (PFS). In addition, a strong association of tumor-infiltrating CD4+ cells and the presence of CD44s expression in tumor samples was observed. These findings reinforce the idea that TIL and the expression of tumor markers should be taken into consideration in order to improve OST treatment and management.Osteosarcoma (OST) is the most common type of high-grade primary bone tumor, which mainly affects young adults. The current standard of care for OST combines surgical resection with chemotherapy. The clinical outcomes and the current options to treat OST patients are unsatisfactory and novel treatment strategies are needed. The crosstalk between tumor cells and immune cells is essential to the OST microenvironment. Despite the efforts that have been made to address the importance of immune-related factors in OST, there is still a lot to understand. The purpose of the current study was to evaluate the tumor-infiltrating lymphocytes (TIL), the expression of proteins involved in tumor biology, and their impact on the clinical outcome of OST patients. We studied 93 samples of OST patients using immunohistochemistry and histomorphometry. We looked for the infiltration of CD3+, CD4+, CD8+, TIA1+ and CD20+ cells and for the expression of CD44 standard (CD44s) and variant 6 (CD44v6), CD95/Fas, Fas-L, p53 and p-glycoprotein. All the parameters were analyzed for the influence on the occurrence of death and metastasis, plus patient overall survival (OS) and progression-free survival (PFS). The effect of sex, age, tumor location (distal femur or proximal tibia) and the combination with neoadjuvant chemotherapy was also assessed. Our results suggest that the presence of tumor-infiltrating CD4+ cells provides protection to OST patients, and that CD8+ cells have a significant impact on the patient’s overall survival (OS) and progression-free survival (PFS), which is more evident in male patients. In addition, a strong association between tumor-infiltrating CD4+ cells and the presence of CD44s expression in tumor samples was observed. Analysis of TIL and tumor markers related to tumor biology could be useful to stratify patients and monitor the response to therapy, as well as to assist with the development of immunotherapy strategies to improve the effects of cytotoxic TIL to eradicate the tumor cells.
Highlights
Conventional osteosarcoma (OST) is the most common type of high-grade primary bone tumor, which mainly affects young adults [1]
We wanted to examine the presence of tumor-infiltrating lymphocytes (TIL) in the histologic sections of tumor tissue obtained from the 93 OST patients included in the study
From the IHC analysis, we showed that more than 50% of the samples had inflammatory infiltrates consisting of CD3+ cells (89%, N = 81/91), CD8+ cells (78%, N = 71/91) and
Summary
Conventional osteosarcoma (OST) is the most common type of high-grade primary bone tumor, which mainly affects young adults [1]. The therapeutic strategy consists of local control surgery, combined with pre- and postoperatively systemic chemotherapy to reduce the likelihood of the disease spreading [3]. For localized OST, the 5-year rate of survival is 70%; OST often metastasizes and the 5-year survival rate for recurrent or metastatic disease drastically declines to less than 20% [4,5]. In advanced OST, multidrug resistance to chemotherapy is a recurrent problem, and the only curative treatment is complete surgical resection of the metastasis, which is a challenging process most of the time [6]. Despite targeted or immune therapies being widely used in various cancers, so far no other strategies have been introduced in OST clinical practice [3]. The clinical outcomes, and the current options to treat
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