{"title":"Prognostic Significance of Immune and Stromal Components in Colorectal Cancer: Practical Tools for Routine Pathologic Assessment.","authors":"Mi Jang, Yongki Hong, Soojung Hong, Eun Kyung Kim","doi":"10.5858/arpa.2024-0350-OA","DOIUrl":null,"url":null,"abstract":"<p><strong>Context.—: </strong>In colorectal cancer (CRC), the tumor microenvironment includes cancer-associated fibroblasts and a variety of immune cells, which are increasingly recognized for their prognostic significance.</p><p><strong>Objective.—: </strong>To evaluate the tumor microenvironment in CRC using methodologies applicable in routine pathologic practice.</p><p><strong>Design.—: </strong>A comprehensive evaluation of the local immune response and tumor to stroma ratio (TSR) was performed in 930 CRC cases by thoroughly reviewing the whole hematoxylin-eosin (H&E) slides. Local immune responses were assessed using peritumoral inflammatory infiltration (Klintrup-Mäkinen and modified Klintrup-Mäkinen methods), intratumoral stromal tumor-infiltrating lymphocytes (TILs; International TILs Working Group system and deep stromal TIL system), and Crohn-like lymphoid reaction (CLR).</p><p><strong>Results.—: </strong>In the multivariate analysis, age (>68 years), stage III-IV, microsatellite stability, signet ring cell/undifferentiated carcinoma, extramural venous invasion, high TSR (>50%), and CLR were independent prognostic factors for disease-specific survival. Excluding microsatellite stability, these factors also served as significant prognostic indicators for progression-free survival. Among the 4 methods for measuring local immune response, evaluating the proportion of TILs within the deepest intratumoral stroma was an independent predictor of progression-free survival.</p><p><strong>Conclusions.—: </strong>We suggest that evaluating CLR, TSR, and stromal TILs on hematoxylin-eosin-stained slides represent a practical and straightforward approach with significant prognostic value.</p>","PeriodicalId":93883,"journal":{"name":"Archives of pathology & laboratory medicine","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of pathology & laboratory medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5858/arpa.2024-0350-OA","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Context.—: In colorectal cancer (CRC), the tumor microenvironment includes cancer-associated fibroblasts and a variety of immune cells, which are increasingly recognized for their prognostic significance.
Objective.—: To evaluate the tumor microenvironment in CRC using methodologies applicable in routine pathologic practice.
Design.—: A comprehensive evaluation of the local immune response and tumor to stroma ratio (TSR) was performed in 930 CRC cases by thoroughly reviewing the whole hematoxylin-eosin (H&E) slides. Local immune responses were assessed using peritumoral inflammatory infiltration (Klintrup-Mäkinen and modified Klintrup-Mäkinen methods), intratumoral stromal tumor-infiltrating lymphocytes (TILs; International TILs Working Group system and deep stromal TIL system), and Crohn-like lymphoid reaction (CLR).
Results.—: In the multivariate analysis, age (>68 years), stage III-IV, microsatellite stability, signet ring cell/undifferentiated carcinoma, extramural venous invasion, high TSR (>50%), and CLR were independent prognostic factors for disease-specific survival. Excluding microsatellite stability, these factors also served as significant prognostic indicators for progression-free survival. Among the 4 methods for measuring local immune response, evaluating the proportion of TILs within the deepest intratumoral stroma was an independent predictor of progression-free survival.
Conclusions.—: We suggest that evaluating CLR, TSR, and stromal TILs on hematoxylin-eosin-stained slides represent a practical and straightforward approach with significant prognostic value.