Combined Immunoscore for Prognostic Stratification of Early Stage Non-Small-Cell Lung Cancer

Alice Boscolo, Francesco Fortarezza, Francesca Lunardi, Giovanni Comacchio, Loredana Urso, Stefano Frega, Jessica Menis, Laura Bonanno, Valentina Guarneri, Federico Rea, Pier Franco Conte, Fiorella Calabrese, Giulia Pasello

Research output: Contribution to journalArticlepeer-review

Abstract

Background: To date, no combined immunoscore has been evaluated for prognostic stratification of early stage non-small-cell lung cancer (NSCLC). The main goal of this study was to investigate the prognostic impact of programmed death ligand 1 (PD-L1) expression and different immune cell components (CD4+, CD8+ T-lymphocytes, and CD68+ macrophages) in early stage NSCLC patients, distinguishing peritumoral (PT) and intratumoral (IT) localizations. The secondary aim was to identify a combined immunoscore to optimize the prognostic stratification of NSCLC patients. Methods: This retrospective study included surgical specimens from consecutive chemo-naive stage II–III radically resected NSCLC patients. Immunohistochemistry was carried out to evaluate PD-L1 expression and to quantify IT and PT CD4+, CD8+ T-lymphocytes, and CD68+ macrophages. The impact of a single marker and of a combination of multiple markers on overall survival (OS) was investigated. Results: Seventy-nine patients were included in the study. PD-L1 expression was associated with worse prognosis (3 years OS: 58% in high- compared with 67% in low-expressing tumors), even though without statistical significance. When integrating PT CD8+, CD4+, and CD68 into a combined PT immunoscore, a significant prognostic stratification of patients was obtained and confirmed at multivariate analysis (3 years OS: 86% in patients with low PT immunoscore vs. 59% in patients with high PT immunoscore, p = 0.018). The integration of derived neutrophil/lymphocyte ratio (dNLR) with combined PT immunoscore improved prognostic stratification, with longer OS in patients with low PT immunoscore and low dNLR (p = 0.002). Conclusion: The combined PT immunoscore (CD8+, CD4+, and CD68) integrated with dNLR may be a promising marker for the development of an integrated Tumor, Node, Metastasis (TNM) immunoscore.

Original languageEnglish
Article number564915
Number of pages10
JournalFrontiers in Oncology
Volume10
DOIs
Publication statusPublished - Sep 25 2020

Keywords

  • early stage
  • immune microenvironment
  • NSCLC
  • PD-L1
  • prognosis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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