The "Immunoscore" in rectal cancer: could we search quality beyond quantity of life?

Abstract

Because of the function and anatomical environment of the rectum, therapeutic strategies for local advanced rectal cancer (LARC) must deal with two challenging stressors that are a high-risk of local and distal recurrences and a high-risk of poor quality of life (QoL). Over the last three decades, advances in screening tests, therapies, and combined-modality treatment options and strategies have improved the prognosis of patients with LARC. However, owing to the heterogeneous nature of LARC and genetic status, the patient may not respond to a specific therapy and may be at increased risk of side-effects without the life-prolonging benefit. Indeed, each therapy can cause its own side-effects, which may worsen by a combination of treatments resulting in long-term poor QoL. In LARC, QoL has become even more essential with the increasing incidence of rectal cancer in young individuals. Herein, we analyzed the value of the Immunoscore-Biopsy (performed on tumor biopsy at diagnosis) in predicting outcomes, alone or in association with clinical and imaging data, for each therapy used in LARC.

Keywords: immunoscore; prognosis; radiochemotherapy; rectal cancer; watch and wait.

Figure 1

(A) Left: Representative image of rectal biopsies with tumor region (pink) and normal tissue (blue) or dysplasia excluded from the analysis (blue). Right: CD3+ and CD8+ T cells automatic detection. Bottom: Chart illustrating the IS_B calculation method: Densities of CD3+ and CD8+ T cells in the tumor are converted into percentile. The mean percentile of the densities are then calculated to generate IS_B percentile value, where IS_B low, intermediate and high subgroups are reflected by 0–25%, >25–70% and >70–100% percentile respectively. (B) The frequency of patients in each IS_B groups, according to the Dworak classification in locally advanced rectal cancer patients. (C) Prediction of pathologic response (ypTNM 0–1) based on IS_B mean score and the ycTNM classification ycTNM 0–I. (D) Percentage of recurrence-free in Watch and Wait patients after 5 years of treatment.