Validation of tumor infiltrating lymphocytes (TIL) and tumor budding as predictors of prognosis in patients with stage III colon cancers treated in a FOLFOX-based adjuvant trial: NCCTG N0147 (Alliance).

Authors

null

Frank A. Sinicrope

Mayo Clinic, Rochester, MN

Frank A. Sinicrope , Qian Shi , Hee Eun Lee , Nathan R. Foster , Steven R. Alberts , Thomas C. Smyrk

Organizations

Mayo Clinic, Rochester, MN

Research Funding

NIH

Background: TIL density reflects the anti-tumor immune response; tumor budding indicates an epithelial to mesenchymal transition (EMT). We determined if these features are prognostic in a single colon cancer (CC) stage with known DNA mismatch repair (MMR) status. Methods: TIL densities (per HPF) and tumor buds (per .785 mm2 field) were quantified at light microscopy in 1,532 CC. Tumor budding at invasive margin was defined as single or cluster of ≤ 4 tumor cells. We divided the cohort into training and validation sets. Optimal cutpoints were identified; associations with 3-year disease-free survival (DFS) were evaluated by multivariable Cox regression. Results: TIL and tumor budding cutpoints identified in training set were confirmed in validation set for prognosis. Patients whose tumors had low (≤ 3) vs high TILs were significantly more likely to have higher T, N stage, low histologic grade, left sidedness, worse performance status, non mutated BRAF, and proficient (p) MMR. Tumors with high budding ( > 3) had higher T, N stage; most had pMMR. Overall, significantly shorter DFS was found for tumors with low TILs [HRadj= 1.74 (95% CI 1.35, 2.24), p < .0001], or with high budding [HRadj= 1.37 (1.13, 1.67), p = .0011]. When combined, low TILs plus high budding showed poor DFS [HRadj= 2.07 (1.50, 2.88), p < .0001]. Similar results were found for pMMR tumors (Table). Within dMMR, patients whose tumors had low (≤ 3) vs high TILs had significantly shorter DFS (HRadj= 2.14; p = .0173); budding was not prognostic (Table). Conclusions: Low TILs and high budding were each validated as markers of poor prognosis in FOLFOX-treated stage III CC, indicating that reduced anti-tumor immunity and an EMT phenotype increase tumor aggressiveness. Whereas TILs and budding each stratified pMMR tumors by DFS, only TILs were prognostic in dMMR tumors and identified the subset with poorest survival.

pMMR (n = 1357)
dMMR (n = 153)
HRadj3-year DFSPadjHRadj3-year DFSPadj
TILs
HighRef81%P = .0002Ref78%P = .0173
Low1.65 (1.25, 2.16)71%2.14 (1.14, 4.01)53%
Tumor
Budding
RefP = .0009RefP = .8577
High1.41 (1.15, 1.73)69%1.06 (0.56, 2.02)67%
LowRef79%Ref71%

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Gastrointestinal (Colorectal) Cancer

Track

Gastrointestinal Cancer—Colorectal and Anal

Sub Track

Epidemiology/Outcomes

Citation

J Clin Oncol 36, 2018 (suppl; abstr 3583)

DOI

10.1200/JCO.2018.36.15_suppl.3583

Abstract #

3583

Poster Bd #

76

Abstract Disclosures