Combined immunophenotyping of tumor-infiltrating lymphocytes as a prognostic factor in resected patients with non-small cell lung cancer.

Authors

null

Ross A. Soo

National University Health System, Singapore, Singapore

Ross A. Soo , Bernadette Reyna Asuncion , Marie Loh , Zul Fazreen , Braxton Sim , Min En Nga , Yin Huei Pang , Brendan Pang , Barry Iacopetta , Richie Chuan Teck Soong

Organizations

National University Health System, Singapore, Singapore, National University of Singapore, Singapore, Singapore, Imperial College London, London, United Kingdom, Temasek Polytechnic, Singapore, Singapore, The University of Western Australia, Perth, Australia

Research Funding

No funding sources reported

Background: Current evidence has highlighted the potential role for tumor infiltrating lymphocytes (TILs) in determining the survival of non-small cell lung cancer (NSCLC) patients. Whilst multiple studies have investigated the prognostic role of various subtypes of TILs, data is limited on the co-expression of TILs subpopulations and its clinical relevance. Identifying immune prognostic markers may help select postoperative NSCLC patients with a poorer prognosis for treatment with immunotherapy. We aim to identify NSCLC subgroups according to combined immunophenotypes and investigate their clinical relevance. Methods: A tissue microarray was constructed from 105 cases of resected NSCLC. Immunohistochemistry for TILs with CD3, CD8, FoxP3 and Granzyme B (GZMB) Ab was performed with an autostainer. TILs were quantified using the Vectra Automated Multispectral Imaging System. Low (-) and high (+) densities of TILs were dichotomised by the medians. EGFR and KRAS mutations were determined with Sanger sequencing. Clustering was performed using the heatmap function of R v3.0.2. Associations with clinicopathological variables were assessed by Chi-square analysis, and association with disease-specific survival (DSS) was performed using Cox proportional hazards model analysis. Results: The median age of patients was 64 years, 70% were male, 59% were stage I, and 57% of tumors were adenocarcinoma. Unsupervised clustering revealed 4 major subgroups based on the co-occurrence of high and low densities: FOXP3+/CD3+ (29% of cases), FOXP3+/CD3- (11%), FOXP3-/GZMB+ (28%) and FOXP3-/GZMB- (31%). The FOXP3+/CD3+ phenotype was significantly associated with squamous cell histology (p=0.047). There was no association with other features, including EGFR or KRAS mutation status. Patients with FOXP3+/CD3+ phenotype had a worse DSS (HR 2.17, 95% confidence interval [1.08-4.36], p=0.034) compared to those in other subgroups. Conclusions: Combined immunophenotyping suggests NSCLC may be comprised of four major subgroups. The FOXP3+/CD3+ phenotype may indicate a worse prognosis for patients with resected NSCLC and thus identify patients for immune directed adjuvant therapy.

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Abstract Details

Meeting

2014 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Tumor Biology

Track

Tumor Biology

Sub Track

Other

Citation

J Clin Oncol 32:5s, 2014 (suppl; abstr 11125)

DOI

10.1200/jco.2014.32.15_suppl.11125

Abstract #

11125

Poster Bd #

407

Abstract Disclosures

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