The Immunoscore system predicts prognosis after liver metastasectomy in colorectal cancer liver metastases
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The Immunoscore was initially established to evaluate the prognosis of stage I/II/III colorectal cancer patients. However, the feasibility of the Immunoscore for the prognosis of colorectal cancer liver metastases (CRCLM) has not been reported.
Liver metastases in 249 CRCLM patients were retrospectively analyzed. The Immunoscore was assessed according to the counts and densities of CD3+ and CD8+ T cells in the central- and peritumoral areas by immunohistochemistry. The prognostic role of the Immunoscore for relapse–free survival (RFS) and overall survival (OS) was analyzed with Kaplan–Meier curves and Cox multivariate models, and confirmed via an internal validation. Receiver operating characteristic (ROC) curves were plotted to compare the prognostic values of the Immunoscore and the clinical risk score (CRS) system.
CRCLM patients with high Immunoscores (> 2) had significantly longer RFS [median RFS (95% confidence interval; 95% CI) 21.4 (7.8–35.1) vs. 8.7 (6.8–10.5) months, P < 0.001] and OS [median OS (95% CI): not reached vs. 28.7 (23.2–34.2) months, P < 0.001] than those with low Immunoscores (≤ 2). After stratification by CRS, the Immunoscore retained a statistically significant prognostic value for OS. The areas under the ROC curves (AUROCs) of the Immunoscore and the CRS system for RFS were 0.711 [95% CI 0.642–0.781] and 0.675[95% CI 0.601–0.749] (P = 0.492), whereas the AUROC of the Immunoscore system for OS was larger than that of the CRS system [0.759 (95% CI 0.699–0.818) vs. 0.660 (95% CI 0.592–0.727); P = 0.029].
The Immunoscore of liver metastases can be applied to predict the prognosis of CRCLM patients following liver resection.
KeywordsColorectal cancer liver metastases Tumor-infiltrating lymphocyte Immunoscore Prognosis
Area under the ROC curve
Oxaliplatin and capecitabine
Colorectal cancer liver metastases
Clinical risk score
European society for medical oncology
Irinotecan, 5-Fu and leucovorin
Oxaliplatin, 5-Fu and leucovorin
Oxaliplatin, irinotecan, 5-Fu and leucovorin
Hepatic arterial infusion
Receiver operating characteristic
Irinotecan and capecitabine
We express our gratitude to all the patients for their participation in this study. We also appreciate all our colleagues at the Sun Yat-sen University Cancer Center who participated in administering the treatment in the current study. Medbanks (Beijing) Network Technology Co., Ltd. is thanked for data collection.
YL and RX were involved in the study design, protocol development, and data analysis and interpretation. MH and QS performed the immunohistochemical staining. SY and PS contributed to the Immunoscore evaluation. YW and HL performed the literature search for the study and were involved in data interpretation and writing the report. ZW, FW, YY, BL, DW, PD, GC, XW, ZL, LL, ZP and DW contributed to data collection. All authors reviewed and approved the manuscript for submission.
The work was supported by the Science and Technology Planning Project of Guangdong Province, China (201508020247).
Compliance with ethical standards
Conflicts of interest
The authors declare no conflicts of interest.
All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.