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Front. Immunol. | doi: 10.3389/fimmu.2019.00071

Scoring System for Tumor-Infiltrating Lymphocytes and its Prognostic Value for Gastric Cancer

 Dachuan Zhang1, Wenting He1,  Cao Wu1,  Tan Yan1,  Yang He1, Bin Xu1, 2, 3, Lujun Chen1, 2, 3,  Jingting Jiang1, 2, 3* and  Qing Li1*
  • 1Department of Tumor Biological Treatment, First people's Hospital of Changzhou, China
  • 2Jiangsu Engineering Research Center for Tumor Immunotherapy, China
  • 3Institute of Cell Therapy, Soochow University, China

The tumor microenvironment (TME) is the internal environment of malignant tumor progression, and the host antitumor immune response and normal tissue destruction occur in the TME. Tumor-infiltrating lymphocytes (TIL) is a crucial component of the TME and reflect the host antitumor immune response. The purpose of this study was to discuss the methodology for TIL evaluation and assess the prognostic value of TIL in gastric cancer. In total, we reviewed 1033 gastrectomy cases between 2002 and 2008 at the Third Affiliated Hospital of Soochow University. To understand the prognostic value of TIL in gastric cancer (GC), TIL were assessed by optical microscopy and verified by immunohistochemistry. There is no current consensus on TIL scoring in GC. In this study, we discussed a TIL evaluation system that includes an analysis of the amount and percentage of TIL in a tumor. Ultimately, 439 (52.7%) cases showed high levels of TIL and 394 (47.3%) cases had low levels. There was a statistically significant relationship among TIL, tumor size, histological grade, LN metastasis, nerve invasion, tumor thrombus, pTN stage and WHO subtypes (p<0.001, respectively). TILhi was a positive significant predictor of overall survival (OS) in Kaplan-Meier survival analysis (P<0.001) and multivariate Cox regression analysis (HR=0.431, 95% CI: 0.347-0.534, P<0.001). After surgery, patients with malignant tumors underwent chemoradiotherapy according to standard therapeutic guidelines based on TNM stage. The TNM scoring system cannot reflect the full information of TME; therefore, TIL can be used as a diagnostic supplement. We constructed a nomogram model that showed more predictive accuracy for OS than pTN stage. In summary, this study proves that high levels of TIL are associated with a positive prognosis and that TIL reflect the protective host antitumor immune response.

Keywords: Tumor-infiltrating lymphocytes (TIL), Gastric cancer (GC), prognosis, Tumor microenvironment (TME), CD3 lymphocytes +

Received: 09 Aug 2018; Accepted: 11 Jan 2019.

Edited by:

Ignacio Melero, Center of Applied Medical Research, School of Pharmacy and Nutrition, University of Navarra, Spain

Reviewed by:

Robert J. Canter, University of California, Davis, United States
Rodabe N. Amaria, University of Texas MD Anderson Cancer Center, United States
Franck Pagès, Université Paris Descartes, France  

Copyright: © 2019 Zhang, He, Wu, Yan, He, Xu, Chen, Jiang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
MD, PhD. Jingting Jiang, First people's Hospital of Changzhou, Department of Tumor Biological Treatment, Changzhou, China, jiangjingting@suda.edu.cn
Prof. Qing Li, First people's Hospital of Changzhou, Department of Tumor Biological Treatment, Changzhou, China, liqblk@163.com