| Objective:The tumor infiltrating lymphocytes(TILs)in Rectal cancer(RC)center tumor(CT)and invasive edge were tested by measuring CD3+and CD8+cells Margin(IM)was used to calculate Immunoscore(IS)to evaluate its prognostic value in stage Ⅰ-Ⅲ rectal cancer patients,analyze its relationship with clinicopathological factors and the relationship between recurrence time and survival time,and compare its prognostic ability with AJCC TNM stage.Methods:(1)Rectal cancer patients with detailed information and tumor tissue treated in The People’s Hospital of Guangxi Zhuang Autonomous Region from June 2014 to December 2016 were included.The density of CD3+and CD8+T cells in the tumor center and infiltrating margin of 70 cases of rectal cancer was detected by immunohistochemical method to calculate the Immunoscore.(2)SPSS 26.0 software was used to analyze the relationship between Immunoscore and clinicopathological factors and prognosis of rectal cancer.Results:(1)Among 70 patients,the expression rate of high Immunoscore(I3-I4)was 32.9%(23/70),and that of low Immunoscore(10-I2)was 67.1(47/70).Immunoscore was significantly correlated with recurrence after radical resection of rectal cancer(χ2=16.026,P<0.01).(2)Univariate Cox analysis showed that only postoperative chemoradiotherapy and Immunoscore had significant influence on the overall survival(OS)of tumor related clinicopathological parameters(ALL P<0.05).Only Immunoscore had significant influence on disease-free survival(DFS)(P<0.05).Multivariate Cox analysis showed that Immunoscore was the most important independent prognostic factor in overall survival(OS)(P<0.05).In DFS,multifactorial analysis showed that Immunoscore was still a significant independent prognostic factor(P<0.01).(3)The cumulative 1-year;2-year,3-year;4-year and 5-year survival rates were 67%,63%,54%,45%and 42%,respectively;and the cumulative disease-free survival rates were 79%,74%,68%,53%and 43%,respectively.Cumulative survival rates at 1,2,3,and 5 years were 81%,70%,61%,and 37%in the low Immunoscore group(I0-I2),and 96%,91%,91%,and 87%in the high Immunoscore group(13-14),respectively.The cumulative disease-free survival rates were 57%,51%,37%and 25%in patients with Immunoscore group(I0-12)at 1,2,3 and 5 years postoperatively,respectively.The cumulative disease-free survival rates were 88%;88%;88%;and 78%in the group with high Immunoscore group(13-14),respectively.Overall survival was higher in patients with higher immunoscore than in those with lower Immunoscore(P<0.01).Disease-free survival was also significantly increased in patients with higher Immunoscore(P<0.01).(4)In predicting DFS,the area under ROC curve(AUC)of Immunoscore was 0.726(95%CI:0.602-0.851,P<0.05),and the area under ROC curve(AUC)of AJCC TNM staging was 0.655(95%CI:0.524-0.785,P<0.05).The area under ROC curve(AUC)of the combined risk score prediction model was 0.761(95%CI:0.640-0.883,P<0.05).In predicting OS,the area under ROC curve(AUC)of Immunoscore was 0.700(95%C/:0.577-0.823,P<0.05),and the area under ROC curve(AUC)of AJCC TNM staging was 0.651(95%CI:0.523-0.779,P<0.01).The area under ROC curve(AUC)of the combined risk score prediction model was 0.738(95%Cl:0.621-0.855,P<0.01).Conclusion:Immunoscore was significantly correlated with recurrence after radical resection of rectal cancer.Immunoscore was an independent prognostic factor for OS and DFS.Patients with higher Immunoscore had the lowest risk of postoperative recurrence.Overall survival(OS)and relapse-free survival(DFS)were significantly longer in the high immunological score group(I3-I4)than in the low immunological score group(I0-I2).Immunoscore system may be superior to AJCC TNM staging system in predicting relapse and survival.The prediction model of risk score combined with AJCC TNM staging system and Galon Immunoscore system may be better than AJCC TNM staging system or Galon Immunoscore system alone in predicting relapse status and survival. |
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