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Zhang H, Liu C, Zhai X, Zhang Q, Zhou Y, Huang H, Ding M, Shi Q, Liu Y, Tang Y, Liu G, Wang H. Disfunction of communication among immune cells in minimal-deviation adenocarcinoma of the cervix as an immunotherapeutic opportunity. Int Immunopharmacol 2023; 124:110907. [PMID: 37683397 DOI: 10.1016/j.intimp.2023.110907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
Minimal deviation adenocarcinoma (MDA) of the uterine cervix, also referred to as malignant adenoma, is a rare subtype of cervical adenocarcinoma that exhibits histological characteristics resembling those of benign tumors, resulting in a low diagnostic rate and a lack of effective treatment options. The transcriptomic features of MDA at the single-cell resolution and within the tumor microenvironment (TME) remain unclear. In this study, we conducted single-cell transcriptomic analyses of MDA samples (Ca) and adjacent normal tissues (PCa). The present study reveals the prevalence of dendritic cells (DCs) and T cells in the carcinoma (Ca) of mammary ductal adenocarcinoma (MDA), with DCs undergoing significant metabolic reprogramming and immune stress. Additionally, our findings demonstrate the crucial involvement of DCs and T cells in the pathogenesis and metastatic progression of MDA, as evidenced by single-cell transcriptomic profiling of MDA and HPV samples. This resource provides a more profound understanding of the indolent nature of MDA and may prove useful in the development of MDA immunotherapy.
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Affiliation(s)
- Hui Zhang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Chunhua Liu
- Department of Physiology and Neurobiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250012, China
| | - Xiaoqian Zhai
- Department of Pathology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qianqian Zhang
- Department of Obstetrics and Gynecology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, 250012, China
| | - Yao Zhou
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Hu Huang
- Department of Pathology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Mingde Ding
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Qiang Shi
- Department of Radiology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Yan Liu
- Department of Ultrasound, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China
| | - Ying Tang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, No.87, Dingjiaqiao, Gulou District, Nanjing, 210009, China
| | - Guanghai Liu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Shandong First Medical University, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, 271000, China.
| | - Hongmei Wang
- School of Medicine, Southeast University, No.87, Dingjiaqiao, Gulou District, Nanjing, 210009, China.
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2
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Gultekin M, Beduk Esen CS, Ates Ozdemir D, Yildirim S, Yuce D, Usubutun A, Yildiz F. Stromal or intraepithelial tumor-infiltrating lymphocytes: which one has more prognostic significance in cervical cancer? Arch Gynecol Obstet 2023; 307:969-980. [PMID: 35840843 DOI: 10.1007/s00404-022-06687-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the effect of tumor-infiltrating lymphocytes (TILs) and tumor associated macrophages (TAMs) on treatment results in patients with cervical squamous cell carcinoma who underwent definitive or adjuvant radiotherapy (RT) or chemoradiotherapy (CRT). METHODS Pathological specimens were evaluated from 96 cervical cancer patients who were treated with definitive or adjuvant RT/CRT between April 2001 and January 2020. The percentage of intraepithelial TILs (iTILs) and stromal TILs (sTILs) were calculated, and immunohistochemistry was used for identifying lymphocyte lineage with CD4, CD8, and CD20 antibodies and macrophages with CD68 antibody. Prognostic values of TILs/TAMs on oncological outcomes were evaluated. RESULTS Thirty patients had early-stage disease and 66 patients had advanced-stage disease. Sixty-three and 33 patients received adjuvant RT and definitive CRT, respectively. Low number of sCD20 positive cells was associated with large tumor size and parametrial invasion. In multivariate analysis, low percentage of sTILs and advanced-stage disease were independent poor prognostic factors for overall survival, disease-free survival (DFS), and distant metastasis-free survival; low number of sCD4 positive cells was also an independent poor prognostic factor for DFS. Low percentage of sTILs and low number of sCD8 positive cells was correlated with high rates of distant metastasis (p = 0.038 and p = 0.025, respectively). CONCLUSION sTILs have superior predictive value than iTILs in terms of prognosis. Stromal compartment should be investigated as a routine practice in TIL studies in cervical cancer. Intensifying the treatment in cervical cancer patients with low number of sTILs should be studied in further investigations.
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Affiliation(s)
- Melis Gultekin
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Deniz Ates Ozdemir
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Selma Yildirim
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Deniz Yuce
- Department of Preventive Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Alp Usubutun
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ferah Yildiz
- Department of Radiation Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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3
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Grau-Bejar JF, Garcia-Duran C, Garcia-Illescas D, Mirallas O, Oaknin A. Advances in immunotherapy for cervical cancer. Ther Adv Med Oncol 2023; 15:17588359231163836. [PMID: 37007635 PMCID: PMC10052578 DOI: 10.1177/17588359231163836] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/22/2023] [Indexed: 03/30/2023] Open
Abstract
Cervical cancer still represents a major public health problem, being the fourth most common cancer in incidence and mortality in women worldwide. These figures are unacceptable since cervical cancer, an human papillomavirus-related malignancy, is a largely preventable disease by means of well-established screening and vaccination programs. Patients with recurrent, persistent, or metastatic disease unsuitable for curative therapeutic approaches represent a dismal prognosis population. Until recently, these patients were only candidates for cisplatin-based chemotherapy plus bevacizumab. However, the introduction of immune checkpoint inhibitors has revolutionized the treatment landscape of this disease achieving historical overall survival improvements in both the post-platinum and frontline settings. Interestingly, the clinical development of immunotherapy in cervical cancer is currently advancing to earlier stages of the disease, as the locally advanced setting, whose standard of care has not changed in the last decades with still modest outcomes. As more innovative immunotherapy approaches are in clinical early development in advanced cervical cancer, promising efficacy data are emerging that may shape the future of this disease. This review summarizes the main treatment advances carried out in the field of immunotherapy throughout the past years.
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Affiliation(s)
- Juan Francisco Grau-Bejar
- Gynaecologic Cancer Programme Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Carmen Garcia-Duran
- Gynaecologic Cancer Programme Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - David Garcia-Illescas
- Gynaecologic Cancer Programme Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Oriol Mirallas
- Gynaecologic Cancer Programme Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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4
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Polten R, Kutle I, Hachenberg J, Klapdor R, Morgan M, Schambach A. Towards Novel Gene and Cell Therapy Approaches for Cervical Cancer. Cancers (Basel) 2022; 15:cancers15010263. [PMID: 36612258 PMCID: PMC9818159 DOI: 10.3390/cancers15010263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Cervical cancer is one of the most common malignancies in women, and the majority of cases are caused by infection with high-risk human papilloma virus (HPV) subtypes. Despite effective preventative measures, such as vaccinations against HPV, over 300,000 women die world-wide from cervical cancer each year. Once cervical cancer is diagnosed, treatment may consist of radial hysterectomy, or chemotherapy and radiotherapy, or a combination of therapies dependent upon the disease stage. Unfortunately, overall prognosis for patients with metastatic or recurrent disease remains poor. In these cases, immunotherapies may be useful based on promising preclinical work, some of which has been successfully translated to the clinic. For example, approaches using monoclonal antibodies directed against surface proteins important for control of immune checkpoints (i.e., immune checkpoint inhibitors) were shown to improve outcome in many cancer settings, including cervical cancer. Additionally, initial clinical studies showed that application of cytotoxic immune cells modified to express chimeric antigen receptors (CAR) or T cell receptors (TCR) for better recognition and elimination of tumor cells may be useful to control cervical cancer. This review explores these important topics, including strengths and limitations of standard and developing approaches, and how some novel treatment strategies may be optimally used to offer the best possible treatment for cervical cancer patients.
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Affiliation(s)
- Robert Polten
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Ivana Kutle
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
| | - Jens Hachenberg
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
- Department of Obstetrics and Gynecology, Hannover Medical School, 30625 Hannover, Germany
| | - Rüdiger Klapdor
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
- Department of Obstetrics and Gynecology, Hannover Medical School, 30625 Hannover, Germany
| | - Michael Morgan
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
- Correspondence: (M.M.); (A.S.); Tel.: +49-511-532-6067 (A.S.)
| | - Axel Schambach
- Institute of Experimental Hematology, Hannover Medical School, 30625 Hannover, Germany
- Division of Hematology/Oncology, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- Correspondence: (M.M.); (A.S.); Tel.: +49-511-532-6067 (A.S.)
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5
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de Mey S, Dufait I, De Ridder M. Radioresistance of Human Cancers: Clinical Implications of Genetic Expression Signatures. Front Oncol 2021; 11:761901. [PMID: 34778082 PMCID: PMC8579106 DOI: 10.3389/fonc.2021.761901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 12/12/2022] Open
Abstract
Although radiotherapy is given to more than 50% of cancer patients, little progress has been made in identifying optimal radiotherapy - drug combinations to improve treatment efficacy. Using molecular data from The Cancer Genome Atlas (TCGA), we extracted a total of 1016 cancer patients that received radiotherapy. The patients were diagnosed with head-and-neck (HNSC - 294 patients), cervical (CESC - 166 patients) and breast (BRCA - 549 patients) cancer. We analyzed mRNA expression patterns of 50 hallmark gene sets of the MSigDB collection, which we divided in eight categories based on a shared biological or functional process. Tumor samples were split into upregulated, neutral or downregulated mRNA expression for all gene sets using a gene set analysis (GSEA) pre-ranked analysis and assessed for their clinical relevance. We found a prognostic association between three of the eight gene set categories (Radiobiological, Metabolism and Proliferation) and overall survival in all three cancer types. Furthermore, multiple single associations were revealed in the other categories considered. To the best of our knowledge, our study is the first report suggesting clinical relevance of molecular characterization based on hallmark gene sets to refine radiation strategies.
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Affiliation(s)
- Sven de Mey
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Inès Dufait
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark De Ridder
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Joseph A, Juncheng P, Mondini M, Labaied N, Loi M, Adam J, Lafarge A, Astesana V, Obrist F, Klein C, Bloy N, Stoll G, Signolle N, Genestie C, Damotte D, Alifano M, Leary A, Pautier P, Morice P, Gouy S, Deutsch E, Chargari C, Dieu-Nosjean MC, Cremer I, Michels J, Kroemer G, Castedo M. Metabolic features of cancer cells impact immunosurveillance. J Immunother Cancer 2021; 9:jitc-2021-002362. [PMID: 34162714 PMCID: PMC8231002 DOI: 10.1136/jitc-2021-002362] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2021] [Indexed: 01/27/2023] Open
Abstract
Background Tumors rewire their metabolism to achieve robust anabolism and resistance against therapeutic interventions like cisplatin treatment. For example, a prolonged exposure to cisplatin causes downregulation of pyridoxal kinase (PDXK), the enzyme that generates the active vitamin B6, and upregulation of poly ADP-ribose (PAR) polymerase-1 (PARP1) activity that requires a supply of nicotinamide (vitamin B3) adenine dinucleotide. We investigated the impact of the levels of PDXK and PAR on the local immunosurveillance (ie, density of the antigen presenting cells and adaptive immune response by CD8 T lymphocytes) in two different tumor types. Methods Tumors from patients with locally advanced cervical carcinoma (LACC) and non-small cell lung cancer (NSCLC) were stained for PAR, PDXK, dendritic cell lysosomal associated membrane glycoprotein (DC-LAMP) and CD8 T cell infiltration. Their correlations and prognostic impact were assessed. Cisplatin-resistant NSCLC cell clones isolated from Lewis-lung cancer (LLC) cells were evaluated for PAR levels by immunoblot. Parental (PARlow) and cisplatin-resistant (PARhigh) clones were subcutaneously injected into the flank of C57BL/6 mice. Tumors were harvested to evaluate their immune infiltration by flow cytometry. Results The infiltration of tumors by CD8 T and DC-LAMP+ cells was associated with a favorable overall survival in patients with LACC (p=0.006 and p=0.008, respectively) and NSCLC (p<0.001 for both CD8 T and DC-LAMP cells). We observed a positive correlation between PDXK expression and the infiltration by DC-LAMP (R=0.44, p=0.02 in LACC, R=0.14, p=0.057 in NSCLC), and a negative correlation between PAR levels and CD8 T lymphocytes (R=−0.39, p=0.034 in LACC, R=−0.18, p=0.017 in NSCLC). PARP1 is constitutively hyperactivated in cisplatin-resistant LLC cells manifesting elevated intracellular levels of poly(ADP-ribosyl)ated proteins (PARhigh). Tumors formed by such cancer cells injected into immunocompetent mice were scarcely infiltrated by CD8 T (p=0.028) and antigen presenting cells (p=0.086). Conclusions Oncometabolic features can impact local immunosurveillance, providing new functional links between cisplatin resistance and therapeutic failure.
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Affiliation(s)
- Adrien Joseph
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Pan Juncheng
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Michele Mondini
- INSERM U1030, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Nizar Labaied
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Mauro Loi
- INSERM U1030, Gustave Roussy, Université Paris-Saclay, INSERM, Villejuif, Val-de-Marne, France
| | - Julien Adam
- Pathology Department, Gustave Roussy Institute, Villejuif, Val-de-Marne, France.,Pathology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antoine Lafarge
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Valentina Astesana
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Florine Obrist
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Christophe Klein
- Centre d'Histologie, Imagerie cellulaire et Cytométrie (CHIC), Centre de Recherche des Cordeliers, Paris, Île-de-France, France
| | - Norma Bloy
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France.,Faculté de médecine, Université de Paris Saclay, Kremlin Bicêtre, France
| | - Gautier Stoll
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France.,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France
| | - Nicolas Signolle
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Catherine Genestie
- Pathology Department, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Diane Damotte
- Departments of Pathology and Thoracic Surgery, Hospital Cochin Assistance Publique Hopitaux de Paris, APHP, Paris, Île-de-France, France
| | - Marco Alifano
- Department of Thoracic Surgery, Hospital Cochin Assistance Publique Hopitaux de Paris, APHP, Paris, Île-de-France, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Philippe Morice
- Department of Gynecologic Surgery, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Sebastien Gouy
- Department of Gynecologic Surgery, Gustave Roussy Institute, Villejuif, Île-de-France, France
| | - Eric Deutsch
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Institute, Villejuif, Val-de-Marne, France
| | - Cyrus Chargari
- Radiotherapy Department, Brachytherapy Unit, Gustave Roussy Institute, Villejuif, Val-de-Marne, France
| | - Marie-Caroline Dieu-Nosjean
- Sorbonne University, UMRS 1135, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses (Cimi-Paris), INSERM, Paris, Île-de-France, France
| | - Isabelle Cremer
- INSERM U1138, Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, 75006 Paris, France
| | - Judith Michels
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Guido Kroemer
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France .,Suzhou Institute for Systems Medicine, Chinese Academy of Medical Sciences, Suzhou, China.,Karolinska Institute, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, Sweden.,Pôle de Biologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Maria Castedo
- Equipe 11 labellisée par la Ligue contre le Cancer, Université de Paris, Sorbonne Université, INSERM U1138, Centre de Recherche des Cordeliers, INSERM, Paris, France .,Metabolomics and Cell Biology Platforms, Gustave Roussy Cancer Campus, Villejuif, France
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Bosse T, Lax S, Abu-Rustum N, Matias-Guiu X. The Role of Predictive Biomarkers in Endocervical Adenocarcinoma: Recommendations From the International Society of Gynecological Pathologists. Int J Gynecol Pathol 2021; 40:S102-S110. [PMID: 33570867 PMCID: PMC7969151 DOI: 10.1097/pgp.0000000000000755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To review the scientific evidence related to predictive biomarkers in cervical adenocarcinoma (ADC). The authors reviewed the literature regarding predictive biomarkers in cervical ADC. There were several limitations: (1) there is an overlap between predictive and prognostic biomarkers, as the vast majority of patients are treated with anticancer strategies; (2) in many studies and clinical trials, cervical ADC patients are included in a large series of patients predominantly composed of cervical squamous cell carcinomas; and (3) in most of the studies, and clinical trials, there is no distinction between human papillomavirus (HPV)-associated and HPV-independent cervical ADCs, or between various histologic subtypes. Results obtained from a small group of studies confirm that cervical ADCs exhibit distinct molecular features as compared with squamous carcinomas, and that there are different molecular features between different types of cervical ADCs. Promising areas of interest include ERBB2 (HER2) mutations and PD-L1 expression as predictive biomarkers for anti-HER2 treatment and immunotherapy, respectively. To date, no definitive data can be obtained from the literature regarding predictive biomarkers for cervical ADC. Clinical trials specifically designed for endocervical ADC patients are required to elucidate the predictive value of HER2 mutations and PD-L1 expression. The distinction between HPV-associated and HPV-independent cervical ADCs as well as early involvement of pathologists in the design of future clinical trials are needed to identify new predictive biomarkers in cervical ADC.
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8
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Litwin TR, Irvin SR, Chornock RL, Sahasrabuddhe VV, Stanley M, Wentzensen N. Infiltrating T-cell markers in cervical carcinogenesis: a systematic review and meta-analysis. Br J Cancer 2021; 124:831-841. [PMID: 33257839 PMCID: PMC7884592 DOI: 10.1038/s41416-020-01184-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 10/22/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The host adaptive immune response helps determine which cervical HPV infections persist and progress to precancer and cancer, and systematic characterisation of T-cell infiltration would help inform key steps in cervical carcinogenesis. METHODS A systematic review and meta-analysis were conducted of infiltrating T-cells in normal cervix, low-grade lesions, high-grade lesions, and invasive cancers including epithelial, stromal, and total tissue and the following markers: CD3, CD4, CD8, FoxP3, CD25, and the CD4:CD8 ratio. An additional qualitative review summarised longitudinal data on associations between infiltrating T-cells and cervical disease persistence, regression, progression, or prognosis. RESULTS There were fewer CD3+, CD4+, and CD8+ cells in cervical lesions and more cells in cancers compared to normal epithelium. FoxP3 and CD25+ regulatory T-cell infiltration is high in persistent and precancerous lesions, and longitudinal data show improved outcomes with lower regulatory T-cell levels. CONCLUSIONS Successful immune evasion may reduce T-cell infiltration in HPV infected and precancerous epithelium, while invasive cancers are highly immunogenic, and regulatory T-cell infiltration increases with cervical disease progression. Understanding these factors may have prognostic value and could aid in novel treatment development and clinical guidelines, but published data are highly heterogeneous and leave important gaps to be filled by future studies.
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Affiliation(s)
- Tamara R Litwin
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA.
| | - Sarah R Irvin
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
| | - Rebecca L Chornock
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Vikrant V Sahasrabuddhe
- Breast and Gynecologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA
| | | | - Nicolas Wentzensen
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, USA
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9
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Ohno A, Iwata T, Katoh Y, Taniguchi S, Tanaka K, Nishio H, Nakamura M, Morisada T, Chen G, Saito M, Yaguchi T, Kawakami Y, Aoki D. Tumor-infiltrating lymphocytes predict survival outcomes in patients with cervical cancer treated with concurrent chemoradiotherapy. Gynecol Oncol 2020; 159:329-334. [PMID: 32829964 DOI: 10.1016/j.ygyno.2020.07.106] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/28/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To (i) identify correlations between selected immunogenic factors and clinicopathological characteristics, (ii) determine whether intratumoral abundance of various specific tumor-infiltrating lymphocytes (TILs) is a prognostic indicator in women with Stage II and III cervical cancer who undergo treatment with cisplatin-based concurrent chemoradiotherapy (CCRT), and (iii) investigate subtypes of FOXP3+ T cells in 15 fresh samples of cervical cancer. METHODS In this retrospective study, intratumoral lesions in colposcopic biopsies from 55 women with advanced cervical cancer who subsequently underwent CCRT at our institution were subjected to automatic immunological staining using the following six mouse monoclonal antibodies: anti-CD3, anti-CD4, anti-CD8, anti-CD20, anti-CD206, and anti-FOXP3. Associations between the findings on automatic scoring of the number of each type of TIL in each specimen and various clinicopathological characteristics were analyzed, as were associations between the abundance of various specific types of TIL and survival. Subtypes of FOXP3+ TILs in 15 additional fresh tumor samples were also investigated using flow cytometry. RESULTS Infiltration with CD8+ TILs was associated with pelvic lymph node metastasis. Abundant infiltration by CD3+, CD4+, CD8+, CD206+, and FOXP3+ TILs were statistically significant indicators of better progression-free and overall survival. Regarding subtypes of FOXP3+ TILs, non-Tregs (Fr-III) were found in all samples tested for this. CONCLUSIONS The abundance of various specific intratumoral TILs may be prognostic indicators in patients with advanced cervical cancer undergoing CCRT.
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Affiliation(s)
- Akiko Ohno
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan; Department of Obstetrics and Gynecology, National Hospital Organization Tokyo Medical Center, Japan
| | - Takashi Iwata
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan; Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan.
| | - Yuki Katoh
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan; Division of Anatomical Science, Department of Functional Morphology, Nihon University School of Medicine, Japan
| | - Shiho Taniguchi
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Japan
| | - Kohsei Tanaka
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Hiroshi Nishio
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Masaru Nakamura
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Tohru Morisada
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Guanliang Chen
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan
| | - Miyuki Saito
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
| | - Tomonori Yaguchi
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan
| | - Yutaka Kawakami
- Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Japan; Department of Immunology, School of Medicine, International University of Health and Welfare, Japan
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Japan
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Cao L, Sun PL, He Y, Yao M, Gao H. Immune stromal features in cervical squamous cell carcinoma are prognostic factors for distant metastasis: A retrospective study. Pathol Res Pract 2019; 216:152751. [PMID: 31776057 DOI: 10.1016/j.prp.2019.152751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2019] [Accepted: 11/17/2019] [Indexed: 01/21/2023]
Abstract
AIM Malignant tumors are complex structures that must interact with the surrounding environment for growth and invasiveness. This study aimed to comprehensively catalogue the features of immune cell stromal infiltrates within tumor tissue and peri-tumoral tissue and to determine whether these features have prognostic value in cervical squamous cell carcinoma (CxSCC). METHODS Immune stromal features in primary tumors in 122 patients enriched for CxSCC were histologically and immunohistochemically characterized. RESULTS Distant metastasis was positively correlated with tumor-node-metastasis (TNM) stage (P < 0.001), lymph-vascular invasion (LVI) (P < 0.001), lymph node metastasis (LNM) (P < 0.001), and tumor budding (P = 0.012). Distant metastasis was also associated with the eosinophil infiltration (P = 0.006); Stromal, intratumoral, invasive-margin, squamous intraepithelial lesion (SIL), and perivascular tumor-infiltrating lymphocytes (TILs); CD68+, CD163+, and CD204+ macrophage infiltration. Multivariate proportional hazard regression analyses revealed that LVI; TNM stage; lymph node metastasis; tumor budding; eosinophil infiltration; CD163+ macrophage infiltration; and stromal and intratumoral TILs were independent predictors of poor DMFS in patients with CxSCC. CONCLUSION Primary tumor immune stromal features can be useful in predicting distant metastasis in CxSCC.
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Affiliation(s)
- Lanqing Cao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Ping-Li Sun
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Yangyang He
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Min Yao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
| | - Hongwen Gao
- Department of Pathology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
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Otter SJ, Chatterjee J, Stewart AJ, Michael A. The Role of Biomarkers for the Prediction of Response to Checkpoint Immunotherapy and the Rationale for the Use of Checkpoint Immunotherapy in Cervical Cancer. Clin Oncol (R Coll Radiol) 2019; 31:834-843. [PMID: 31331818 DOI: 10.1016/j.clon.2019.07.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 12/23/2022]
Abstract
Checkpoint immunotherapy has revolutionised the way that melanoma is treated and has also shown significant effectiveness in lung, bladder, renal, and head and neck cancers. At the present time, trials of checkpoint immunotherapy in cervical cancer are at early phases, but there is very good rationale for pursuing this as a treatment option, especially as cervical cancer is a virally driven cancer and therefore should be recognised by the immune system as being foreign. This review explores the biomarkers for the selection of patients for immunotherapy in other cancers, such as programmed death ligand 1 (PD-L1) expression, tumour infiltrating lymphocytes and total mutational burden, and relates these biomarkers to cervical cancer. A PubMed search was carried out for publications published in English with the terms 'immunotherapy' OR 'cervical cancer' OR 'checkpoint blockade' OR 'tumour infiltrating lymphocytes' OR 'total mutational burden'. Articles that met these criteria and were available on PubMed before 8 October 2018 were included. The results showed that PD-L1 is positive in up to 90% of cervical cancers and that the total mutational burden is moderately high, with 5-6 mutations per megabase. In addition, the tumour microenvironment in cervical cancer has an impact on prognosis, with higher ratios of CD8+ tumour infiltrating lymphocytes to CD4+ T regulatory cells being associated with improved survival. Clinical studies to date have shown the response rate of cervical cancer to checkpoint immunotherapy to be in the region to 10-25%. Cervical cancer exhibits many of the features that have been shown to be correlated with response to checkpoint immunotherapy in other tumour sites. However, response rates to date are in the region of 10-25%. Therefore, combinations of immunotherapeutic agents or checkpoint inhibitors with radiotherapy may be required to maximise the therapeutic benefit of harnessing the host immune system to fight cancer.
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Affiliation(s)
- S J Otter
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; Department of Oncology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
| | - J Chatterjee
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; Department of Oncology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - A J Stewart
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; Department of Oncology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - A Michael
- St Luke's Cancer Centre, Royal Surrey County Hospital, Guildford, UK; Department of Oncology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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12
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Liang Y, Lü W, Zhang X, Lü B. Tumor-infiltrating CD8+ and FOXP3+ lymphocytes before and after neoadjuvant chemotherapy in cervical cancer. Diagn Pathol 2018; 13:93. [PMID: 30474571 PMCID: PMC6260654 DOI: 10.1186/s13000-018-0770-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/08/2018] [Indexed: 11/16/2022] Open
Abstract
Background Neoadjuvant chemotherapy (NACT) has been recently accepted as an effective alternative in patients with locally advanced cervical cancer. However, little is known about the effects of NACT on the immunological microenvironment in cervical cancers. In this study, we analyzed the alterations of tumor infiltrating lymphocytes (TILs) before and after NACT and analyzed their prognostic significance in advanced cervical cancer patients treated with platinum-based NACT. Methods We recruited 137 patients with stage Ib2 and IIa2 cervical cancer retrospectively. Pretreatment biopsy and surgical specimens after NACT were immunostained with CD8 and Foxp3. The densities of intratumoral and peritumoral immunopositive TILs were analyzed separately. Results Foxp3+ T cells density significantly decreased in both intratumoral (median 28.49 vs. 19.97; Z = − 8.635, p < 0.001) and peritumoral (median 113.53 vs. 82.48; Z = − 3.741, p < 0.001) areas after NACT, whereas CD8+ T cell counts remained stable in both intratumoral (median 121.32 vs. 109.59; Z = − 0.817,p = 0.414) and peritumoral (median 402.56 vs. 390.84; Z = − 1.138,p = 0.255) areas. Patients with pathological complete response (pCR) had significantly lower number of Foxp3+ T cell density after NACT than non-pCR cases in both intratumoral (median16.12 vs. 22.00; Z = − 2.009, p = 0.045) and peritumoral areas(median 63.31 vs. 98.48; Z = − 2.469, p = 0.014). Multivariate analyses demonstrated that high ratio of intratumoral CD8/peritumoral Foxp3 in residual tumors was independent prognostic factor for both progression-free survival (HR = 0.297; 95% CI, 0.109–0.810, p = 0.018) and overall survival (HR = 0.078; 95% CI, 0.010–0.598, p = 0.014). Conclusions NACT in cervical cancers can induce anti-cancer immunity by altering TILs subsets. An elevated intratumoral CD8/peritumoral Foxp3 ratio after NACT may confer a favorable clinical outcome.
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Affiliation(s)
- Yun Liang
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China
| | - Weiguo Lü
- Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China.,Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China
| | - Xiaofei Zhang
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China
| | - Bingjian Lü
- Department of Surgical Pathology, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China. .,Center for Uterine Cancer Diagnosis & Therapy of Zhejiang Province, Women's Hospital, School of Medicine, Zhejiang University, Province, Zhejiang, 310006, China.
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13
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Curigliano G. Gyneco-oncological genomics and emerging biomarkers for cancer treatment with immune-checkpoint inhibitors. Semin Cancer Biol 2018; 52:253-258. [DOI: 10.1016/j.semcancer.2018.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/14/2018] [Indexed: 12/20/2022]
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14
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Komdeur FL, Prins TM, van de Wall S, Plat A, Wisman GBA, Hollema H, Daemen T, Church DN, de Bruyn M, Nijman HW. CD103+ tumor-infiltrating lymphocytes are tumor-reactive intraepithelial CD8+ T cells associated with prognostic benefit and therapy response in cervical cancer. Oncoimmunology 2017; 6:e1338230. [PMID: 28932636 PMCID: PMC5599086 DOI: 10.1080/2162402x.2017.1338230] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/29/2017] [Accepted: 05/30/2017] [Indexed: 01/29/2023] Open
Abstract
Human papilloma virus (HPV)-induced cervical cancer constitutively expresses viral E6/E7 oncoproteins and is an excellent target for T cell-based immunotherapy. However, not all tumor-infiltrating T cells confer equal benefit to patients, with epithelial T cells being superior to stromal T cells. To assess whether the epithelial T cell biomarker CD103 could specifically discriminate the beneficial antitumor T cells, association of CD103 with clinicopathological variables and outcome was analyzed in the TCGA cervical cancer data set (n = 304) and by immunohistochemistry (IHC) in an independent cohort (n = 460). Localization of CD103+ cells in the tumor was assessed by immunofluorescence. Furthermore, use of CD103 as a response biomarker was assessed in an in vivo E6/E7+ tumor model. Our results show that CD103 gene expression was strongly correlated with cytotoxic T cell markers (e.g. CD8/GZMB/PD1) in the TCGA series. In line with this, CD103+ cells in the IHC series co-expressed CD8 and were preferentially located in cervical tumor epithelium. High CD103+ cell infiltration was strongly associated with an improved prognosis in both series, and appeared to be a better predictor of outcome than CD8. Interestingly, the prognostic benefit of CD103 in both series seemed limited to patients receiving radiotherapy. In a preclinical mouse model, HPV E6/E7-targeted therapeutic vaccination in combination with radiotherapy increased the intratumoral number of CD103+ CD8+ T cells, providing a potential mechanistic basis for our results. In conclusion, CD103 is a promising marker for rapid assessment of tumor-reactive T cell infiltration of cervical cancers and a promising response biomarker for E6/E7-targeted immunotherapy.
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Affiliation(s)
- Fenne L Komdeur
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Thalina M Prins
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Stephanie van de Wall
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, The Netherlands
| | - Annechien Plat
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - G Bea A Wisman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Harry Hollema
- University of Groningen, University Medical Center Groningen, Department of Pathology, The Netherlands
| | - Toos Daemen
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, The Netherlands
| | - David N Church
- University of Oxford, Oxford Cancer Centre, Churchill Hospital Molecular and Population Genetics Laboratory, The Wellcome Trust Centre for Human Genetics, Oxford, United Kingdom
| | - Marco de Bruyn
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
| | - Hans W Nijman
- University of Groningen, University Medical Center Groningen, Department of Obstetrics and Gynecology, The Netherlands
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15
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Bryan RB, Gough MJ, Seung SK, Jutric Z, Weinberg AD, Fox BA, Crittenden MR, Leidner RS, Curti B. Cytoreductive surgery for head and neck squamous cell carcinoma in the new age of immunotherapy. Oral Oncol 2016; 61:166-76. [PMID: 27614589 DOI: 10.1016/j.oraloncology.2016.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
Cytoreductive surgery is an approach to cancer treatment that aims to reduce the number of cancer cells via resection of primary tumor or metastatic deposits, in an effort to minimize a potentially immunosuppressive tumor burden, palliate symptoms, and prevent complications. Furthermore, it provides a platform for investigation of biomarkers with the goal of optimizing immunotherapy to reverse the immunosuppressive tumor microenvironment and enhance adaptive immune responses. Ultimately, our group aims to exploit the concept that successful cancer therapy is dependent upon an effective immune response. Surgery will remain an integral part of head and neck squamous cell carcinoma (HNSCC) treatment in the future, even as checkpoint inhibitors, co-stimulatory molecules, vaccines, adoptive T cell therapy and other novel agents enter clinical routine. Cytoreductive resection may provide an effective platform for immunotherapy and biomarker directed interventions to improve outcomes for patients with HNSCC.
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Affiliation(s)
- R Bryan Bryan
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St. Suite 6N50, Portland, OR 97213, United States; Head and Neck Institute, 1849 NW Kearney, Suite 300, Portland, OR 97209, United States.
| | - Michael J Gough
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States
| | - Steven K Seung
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St. Suite 6N50, Portland, OR 97213, United States; The Oregon Clinic, Department of Radiation Oncology, 4805 NE Glisan St., Portland, OR 97213, United States
| | - Zeljka Jutric
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States
| | - Andrew D Weinberg
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States
| | - Bernard A Fox
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States
| | - Marka R Crittenden
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St. Suite 6N50, Portland, OR 97213, United States; The Oregon Clinic, Department of Radiation Oncology, 4805 NE Glisan St., Portland, OR 97213, United States
| | - Rom S Leidner
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States; Providence Oral, Head and Neck Cancer Program and Clinic, Providence Cancer Center, Providence Portland Medical Center, 4805 NE Glisan St. Suite 6N50, Portland, OR 97213, United States
| | - Brendan Curti
- Earle A. Chiles Research Institute at Providence Cancer Center, 4805 NE Glisan St. Suite 2N35, Portland, OR 97213, United States
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Hinrichs CS, Rosenberg SA. Exploiting the curative potential of adoptive T-cell therapy for cancer. Immunol Rev 2014; 257:56-71. [PMID: 24329789 DOI: 10.1111/imr.12132] [Citation(s) in RCA: 357] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Adoptive T-cell therapy (ACT) is a potent and flexible cancer treatment modality that can induce complete, durable regression of certain human malignancies. Long-term follow-up of patients receiving tumor-infiltrating lymphocytes (TILs) for metastatic melanoma reveals a substantial subset that experienced complete, lasting tumor regression - and may be cured. Increasing evidence points to mutated gene products as the primary immunological targets of TILs from melanomas. Recent technological advances permit rapid identification of the neoepitopes resulting from these somatic gene mutations and of T cells with reactivity against these targets. Isolation and adoptive transfer of these T cells may improve TIL therapy for melanoma and permit its broader application to non-melanoma tumors. Extension of ACT to other malignancies may also be possible through antigen receptor gene engineering. Tumor regression has been observed following transfer of T cells engineered to express chimeric antigen receptors against CD19 in B-cell malignancies or a T-cell receptor against NY-ESO-1 in synovial cell sarcoma and melanoma. Herein, we review recent clinical trials of TILs and antigen receptor gene therapy for advanced cancers. We discuss lessons from this experience and consider how they might be applied to realize the full curative potential of ACT.
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S100 expression in dendritic cells is inversely correlated with tumor grade in endometrial carcinoma. Obstet Gynecol Sci 2014; 57:201-7. [PMID: 24883291 PMCID: PMC4038686 DOI: 10.5468/ogs.2014.57.3.201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/18/2013] [Accepted: 11/25/2013] [Indexed: 11/08/2022] Open
Abstract
Objective The aim of this study was to determine the expression of S100 positive dendritic cells (DCs) and the relationship with clinicopathologic factors in endometrial carcinoma. Methods Samples were collected from 89 patients with endometrial endometrioid adenocarcinoma treated in Pusan National University Hospital from 2004 to 2011. Normal endometrial tissues were obtained from 30 hysterectomized women with benign adnexal masses and served as controls. Paraffin-embedded sections were immunohistochemically stained for S100 was performed, and the number of positive DCs was counted. The relationship of these cells to the stage, histological grade, myometrial invasion, and lymph node metastasis was analyzed. Results The proportion of S100-positive DCs in the endometrial endometrioid adenocarcinoma was 31.5% (28/89), which was significantly higher (P<0.05) than in the control group. The proportion of S100-positive DC expression was negatively correlated with the histologic grade, but was not associated with the stage, myometrial invasion, or lymph node metastasis. Conclusion High DC density was inversely correlated with histologic grade in endometrial carcinoma. Tumor-infiltrating S100+ DCs may be used as pathologic marker in endometrial carcinoma.
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Nordfors C, Grün N, Tertipis N, Ährlund-Richter A, Haeggblom L, Sivars L, Du J, Nyberg T, Marklund L, Munck-Wikland E, Näsman A, Ramqvist T, Dalianis T. CD8+ and CD4+ tumour infiltrating lymphocytes in relation to human papillomavirus status and clinical outcome in tonsillar and base of tongue squamous cell carcinoma. Eur J Cancer 2013; 49:2522-30. [DOI: 10.1016/j.ejca.2013.03.019] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/07/2013] [Accepted: 03/09/2013] [Indexed: 02/02/2023]
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Choyce A, Yong M, Narayan S, Mattarollo SR, Liem A, Lambert PF, Frazer IH, Leggatt GR. Expression of a single, viral oncoprotein in skin epithelium is sufficient to recruit lymphocytes. PLoS One 2013; 8:e57798. [PMID: 23469070 PMCID: PMC3582605 DOI: 10.1371/journal.pone.0057798] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 01/26/2013] [Indexed: 11/19/2022] Open
Abstract
Established cancers are frequently associated with a lymphocytic infiltrate that fails to clear the tumour mass. In contrast, the importance of recruited lymphocytes during premalignancy is less well understood. In a mouse model of premalignant skin epithelium, transgenic mice that express the human papillomavirus type 16 (HPV16) E7 oncoprotein under a keratin 14 promoter (K14E7 mice) display epidermal hyperplasia and have a predominant infiltrate of lymphocytes consisting of both CD4 and CD8 T cells. Activated, but not naïve T cells, were shown to preferentially traffic to hyperplastic skin with an increased frequency of proliferative CD8+ T cells and CD4+ T cells expressing CCR6 within the tissue. Disruption of the interaction between E7 protein and retinoblastoma tumour suppressor protein (pRb) led to reduced epithelial hyperplasia and T cell infiltrate. Finally, while K14E7 donor skin grafts are readily accepted onto syngeneic, non-transgenic recipients, these same skin grafts lacking skin-resident lymphocytes were rejected. Our data suggests that expression of a single oncoprotein in the epidermis is sufficient for lymphocyte trafficking (including immunosuppressive lymphocytes) to premalignant skin.
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Affiliation(s)
- Allison Choyce
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Michelle Yong
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Sharmal Narayan
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Stephen R. Mattarollo
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Amy Liem
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Paul F. Lambert
- McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, United States of America
| | - Ian H. Frazer
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
| | - Graham R. Leggatt
- The University of Queensland Diamantina Institute, University of Queensland, Princess Alexandra Hospital, Woolloongabba, Brisbane, Australia
- * E-mail:
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Hou F, Li Z, Ma D, Zhang W, Zhang Y, Zhang T, Kong B, Cui B. Distribution of Th17 cells and Foxp3-expressing T cells in tumor-infiltrating lymphocytes in patients with uterine cervical cancer. Clin Chim Acta 2012; 413:1848-54. [DOI: 10.1016/j.cca.2012.07.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/21/2012] [Accepted: 07/10/2012] [Indexed: 01/26/2023]
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Gadducci A, Guerrieri ME, Greco C. Tissue biomarkers as prognostic variables of cervical cancer. Crit Rev Oncol Hematol 2012; 86:104-29. [PMID: 23031678 DOI: 10.1016/j.critrevonc.2012.09.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 07/02/2012] [Accepted: 09/04/2012] [Indexed: 01/05/2023] Open
Abstract
The most important prognostic variables of cervical carcinoma are FIGO stage, lymph node status and clinical-pathological features of primary tumor. Recently, there has been increasing interest in the identification of biomarkers able to predict both response to treatment and survival. The aim of this review is to critically evaluate current published evidence on the ability of various tissue biomarkers to predict the clinical outcome of patients with cervical carcinoma. In particular, the paper takes into account DNA content, cell-cycle and apoptosis-regulatory proteins, epidermal growth factor receptor [EGFR], vascular endothelial growth factor [VEGF], cyclooxygenase [COX]-2, signal transducer and activator of transcription [Stat]3, human papilloma virus [HPV] status, tumor hypoxia, tumor infiltrating lymphocytes [TIL], microarray technology and microRNA (miRNA). The presence of HPV-18 genotype and an elevated VEGF expression appear to be poor prognostic factors in women with early disease treated with primary surgery, whereas the expression of EGFR, VEGF, COX-2 and tumor hypoxia may have a major impact on the survival of patients treated with definitive radiotherapy or chemoradiation. The data supporting the reliability of ΔNp73 and TAp73α as novel biomarkers of response to radiotherapy are interesting but still limited. DNA microarray technology could offer new laboratory tools for a rationale planning of treatment strategy, and miRNAs might represent new candidate targets to be investigated for both prognostic and therapeutic purposes. Moreover, the assessment of different types of TIL and their ligands in tumor biopsies could enable the identification of a subset of high-risk patients, paving the way to novel immune therapies aimed at blocking T-reg cell activity.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy.
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Karthaus N, Torensma R, Tel J. Deciphering the message broadcast by tumor-infiltrating dendritic cells. THE AMERICAN JOURNAL OF PATHOLOGY 2012; 181:733-42. [PMID: 22796439 DOI: 10.1016/j.ajpath.2012.05.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/25/2012] [Accepted: 05/17/2012] [Indexed: 02/07/2023]
Abstract
Human dendritic cells (DCs) infiltrate solid tumors, but this infiltration occurs in favorable and unfavorable disease prognoses. The statistical inference is that tumor-infiltrating DCs (TIDCs) play no conclusive role in predicting disease progression. This is remarkable because DCs are highly specialized antigen-presenting cells linking innate and adaptive immunity. DCs either boost the immune system (enhancing immunity) or dampen it (leading to tolerance). This dual effect explains the dual outcomes of cancer progression. The reverse functional characteristics of DCs depend on their maturation status. This review elaborates on the markers used to detect DCs in tumors. In many cases, the identification of DCs in human cancers relies on staining for S-100 and CD1a. These two markers are mainly expressed by Langerhans cells, which are one of several functionally different DC subsets. The activation status of DCs is based on the expression of CD83, DC-SIGN, and DC-LAMP, which are nonspecific markers of DC maturation. The detection of TIDCs has not kept pace with the increased knowledge about the identification of DC subsets and their maturation status. Therefore, it is difficult to draw a conclusion about the performance of DCs in tumors. We suggest a novel selection of markers to distinguish human DC subsets and maturation states. The use of these biomarkers will be of pivotal importance to scrutinize the prognostic significance of TIDCs.
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Affiliation(s)
- Nina Karthaus
- Department of Tumor Immunology, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, The Netherlands
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Jewett A, Tseng HC. Tumor induced inactivation of natural killer cell cytotoxic function; implication in growth, expansion and differentiation of cancer stem cells. J Cancer 2011; 2:443-57. [PMID: 21850212 PMCID: PMC3157021 DOI: 10.7150/jca.2.443] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 08/05/2011] [Indexed: 12/20/2022] Open
Abstract
Accumulated evidence indicates that cytotoxic function of immune effectors is largely suppressed in the tumor microenvironment by a number of distinct effectors and their secreted factors. The aims of this review are to provide a rationale and a potential mechanism for immunosuppression in cancer and to demonstrate the significance of such immunosuppression in cellular differentiation and progression of cancer. To that end, we have recently shown that NK cells mediate significant cytotoxicity against primary oral squamous carcinoma stem cells (OSCSCs) as compared to their more differentiated oral squamous carcinoma cells (OSCCs). In addition, human embryonic stem cells (hESCs), Mesenchymal Stem Cells (hMSCs), dental pulp stem cells (hDPSCs) and induced pluripotent stem cells (hiPSCs) were all significantly more susceptible to NK cell mediated cytotoxicity than their differentiated counterparts or parental cells from which they were derived. We have also reported that inhibition of differentiation or reversion of cells to a less-differentiated phenotype by blocking NFκB or targeted knock down of COX2 in primary monocytes in vivo significantly augmented NK cell function. Total population of monocytes and those depleted of CD16(+) subsets were able to substantially prevent NK cell mediated lysis of OSCSCs, MSCs and DPSCs. Taken together, our results suggest that stem cells are significant targets of the NK cell cytotoxicity. The concept of split anergy in NK cells and its contribution to tissue repair and regeneration and in tumor resistance and progression will be discussed in this review.
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Affiliation(s)
- Anahid Jewett
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, and Division of Oral Biology and Medicine, UCLA School of Dentistry, University of California, Los Angeles, CA 90095, USA
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Sundlisaeter E, Røsland GV, Hertel JK, Sakariassen PØ, Almås B, Dicko A, Søndenaa K. Increased lymphatic vascular density is seen before colorectal cancers reach stage II and growth factor FGF-2 is downregulated in tumor tissue compared with normal mucosa. APMIS 2009; 117:212-21. [PMID: 19245594 DOI: 10.1111/j.1600-0463.2008.00025.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lymphangiogenesis is an important event in progression of colorectal cancer (CRC), and the estimated lymphatic vascular density (LVD) probably indicates facilitated lymphatic tumor cell invasion and metastasis. However, at what time point during tumor progression this process is triggered, is unclear. The aim of this study was twofold. Firstly, to examine LVD in paired samples of CRC tissue and normal mucosa with specific emphasis on possible difference in LVD between tumors stages II and III, and secondly, the expression of the lymphangiogenic growth factor fibroblast growth factor-2 (FGF-2). Eighteen patients were studied. Immunostaining for podoplanin was performed to highlight lymphatic vessels. FGF-2 mRNA expression was determined by quantitative real-time RT-PCR, whereas protein expression was quantitatively assessed by densitometric analysis of Western blot signal intensity. The immunoblots were further validated by FGF-2 immunostaining of histological sections. LVD was significantly increased in tumor tissue compared with the normal mucosa but no changes in LVD between stages II and III CRC was observed. FGF-2 was found to be downregulated both at the mRNA and protein level in tumor tissues compared with normal mucosa. Lymphangiogenesis was triggered early in tumor development. An increased LVD was established before the tumor reached stage II. FGF-2 was downregulated in tumor tissue. The importance of this finding remains unclear.
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Affiliation(s)
- Eirik Sundlisaeter
- Department of Biomedicine, University of Bergen, Jonas Lies vei 91, Bergen, Norway.
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Bobryshev YV, Tran D, Killingsworth MC, Buckland M, Lord RVN. Dendritic cells in Barrett's esophagus and esophageal adenocarcinoma. J Gastrointest Surg 2009; 13:44-53. [PMID: 18685901 DOI: 10.1007/s11605-008-0613-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2008] [Accepted: 07/08/2008] [Indexed: 01/31/2023]
Abstract
BACKGROUND Like other premalignant conditions that develop in the presence of chronic inflammation, the development and progression of Barrett's esophagus is associated with the development of an immune response, but how this immune response is regulated is poorly understood. A comprehensive literature search failed to find any report of the presence of dendritic cells in Barrett's intestinal metaplasia and esophageal adenocarcinoma and this prompted our study. MATERIAL AND METHODS We used immunohistochemical staining and electron microscopy to examine whether dendritic cells are present in Barrett's esophagus and esophageal adenocarcinoma. Immunohistochemical staining with CD83, a specific marker for dendritic cells, was performed on paraffin-embedded sections of Barrett's intestinal metaplasia (IM, n = 12), dysplasia (n = 11) and adenocarcinoma (n = 14). RESULTS CD83+ cells were identified in the lamina propria surrounding intestinal type glands in Barrett's IM, dysplasia, and cancer tissues. Computerized quantitative analysis showed that the numbers of dendritic cells were significantly higher in cancer tissues. Double immunostaining with CD83, CD20, and CD3, and electron microscopy demonstrated that dendritic cells are present in Barrett's esophagus and form clusters with T cells and B cells directly within the lamina propria. CONCLUSIONS These findings demonstrate that dendritic cells are present in Barrett's tissues, with a significant increase in density in adenocarcinoma compared to benign Barrett's esophagus. Dendritic cells may have a role in the pathogenesis and immunotherapy treatment of Barrett's esophagus and adenocarcinoma.
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Affiliation(s)
- Yuri V Bobryshev
- Department of Surgery and Centre for Immunology, St Vincent's Hospital, University of New South Wales, Sydney, Australia
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Wertel I, Polak G, Bednarek W, Barczyński B, Roliński J, Kotarski J. Dendritic cell subsets in the peritoneal fluid and peripheral blood of women suffering from ovarian cancer. CYTOMETRY PART B-CLINICAL CYTOMETRY 2008; 74:251-8. [PMID: 18302193 DOI: 10.1002/cyto.b.20410] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Evaluation of immature myeloid and lymphoid dendritic cells (DCs) in the peritoneal fluid (PF) and peripheral blood (PB) mononuclears of women with ovarian carcinoma (n = 47) and benign ovarian tumors (n = 37). METHODS Mononuclear cells were isolated from PF and PB, stained with monoclonal antibodies (mAbs) against DC antigens (anti-BDCA-1, anti-BDCA-2), and estimated using flow cytometry. RESULTS The percentage of PF myeloid DC (MDC) in mononuclears was significantly lower in patients with ovarian cancer in comparison to the group of nonmalignant ovarian tumors (0.65% and 6.95%). The percentage of PF lymphoid DCs (LDCs) was higher in patients with ovarian cancer than in the reference group (0.64% and 0.09%). The percentage of PB MDCs and LDCs did not differ significantly between studied groups. In women suffering from ovarian cancer the percentage of both MDCs and LDCs was higher in the PF than in the PB. In the reference group the percentage of MDCs was higher but that of LDCs was lower in the PF than in the PB. In women with ovarian cancer, PF MDCs/LDCs ratio was lower in comparison to patients with serous cystadenoma. In PB the ratio of MDCs to LDCs did not differ significantly between studied groups. CONCLUSIONS We concluded that MDCs population may be affected by the presence of malignant disease. LDC subsets may have influence on the local immune response in the PF of women with malignant tumors of the ovary. (c) 2008 Clinical Cytometry Society.
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Affiliation(s)
- I Wertel
- 1st Department of Gynaecology, University School of Medicine, Lublin, Poland.
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Quantification of Dendritic Cells and Osteoclasts in the Bone Marrow of Patients with Monoclonal Gammopathy. Pathol Oncol Res 2008; 15:65-72. [DOI: 10.1007/s12253-008-9092-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Accepted: 07/28/2008] [Indexed: 10/21/2022]
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Jordanova ES, Gorter A, Ayachi O, Prins F, Durrant LG, Kenter GG, van der Burg SH, Fleuren GJ. Human leukocyte antigen class I, MHC class I chain-related molecule A, and CD8+/regulatory T-cell ratio: which variable determines survival of cervical cancer patients? Clin Cancer Res 2008; 14:2028-35. [PMID: 18381941 DOI: 10.1158/1078-0432.ccr-07-4554] [Citation(s) in RCA: 174] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the effect of intraepithelial tumor-infiltrating lymphocytes (ieTIL) and their ligands expressed by cervical tumor cells on the outcome of cervical cancer patients. EXPERIMENTAL DESIGN The prognostic value of ieTILs was investigated in 115 cases of cervical cancer. T-cell subsets, CD57(+) cells, and regulatory T cells (Treg) were enumerated. The associations of these different ieTIL subtypes with human leukocyte antigen (HLA) class I and MHC class I chain-related molecule A (MICA) expression were determined in relation to clinical variables and patient survival. RESULTS Survival analysis showed that a high number of intraepithelial Treg (FoxP3(+)), a low CD8(+)/regulatory T-cell ratio, and a weak HLA-A expression were all associated with worse survival (P=0.034, 0.025, and 0.033, respectively, log-rank test). Further stratification of patient groups based on HLA-A-MICA expression and HLA-A-MICA-CD8(+)/Treg ratio revealed an even poorer survival (P=0.005). In a multivariate Cox analysis, low CD8(+)/Treg ratio (P=0.047), weak HLA-A-MICA expression (P=0.003), and weak HLA-A-MICA expression combined with low CD8(+)/Treg ratio (P=0.002) were all found to be independent unfavorable prognostic predictors in cervical carcinoma (hazard ratios, 2.7, 4.0, and 4.9, respectively). CONCLUSION Weak HLA-A-MICA expression combined with low CD8(+)/Treg ratio reveals a patient group with the poorest survival in cervical cancer. As a single variable, low CD8(+)/Treg ratio was a significant independent unfavorable prognostic factor.
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Nedergaard BS, Nielsen K, Nyengaard JR, Ladekarl M. Stereologic estimation of the total numbers, the composition and the anatomic distribution of lymphocytes in cone biopsies from patients with stage I squamous cell carcinoma of the cervix uteri. APMIS 2008; 115:1321-30. [PMID: 18184401 DOI: 10.1111/j.1600-0643.2007.00655.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to present a method to obtain basic biological data on the in situ cellular immune response towards cancer. Using stereology, we estimated the density and frequency of immune cells of 10 different phenotypes in cone biopsies from 20 patients with FIGO stage I cervical squamous cell carcinoma. The anatomic distribution of immune cells with respect to intraepithelial, periepithelial or stromal compartments was recorded in normal epithelium, dysplastic epithelium and carcinoma. We estimated the number of immune cells per cancer cell, and the 3D total number of immune cells, inside cancer tissue. The tumor volume was estimated in 3D and corrected for shrinkage occurring during tissue processing. We found more immune cells in cancer compared to dysplasia and normal epithelia. A median total number of 278 . 10(3) CD3+, 69.1 . 10(3) CD4+ and 113 . 10(3) CD8+ cells were present in the cancers. A median number of 63 CD3+, 11 CD4+ and 29 CD8+ cells were present per cancer cell. The average volume of tumors in stage IA was significantly smaller than that of stage IB. This method was found to be usable and of potential value in clinical pathology research, and for development and evaluation of immunotherapy.
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Affiliation(s)
- Bettina S Nedergaard
- Department of Oncology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
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Piersma SJ, Welters MJP, van der Hulst JM, Kloth JN, Kwappenberg KMC, Trimbos BJ, Melief CJM, Hellebrekers BW, Fleuren GJ, Kenter GG, Offringa R, van der Burg SH. Human papilloma virus specific T cells infiltrating cervical cancer and draining lymph nodes show remarkably frequent use of HLA-DQ and -DP as a restriction element. Int J Cancer 2008; 122:486-94. [PMID: 17955486 DOI: 10.1002/ijc.23162] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Human papillomavirus (HPV)-induced malignancies are frequently infiltrated by lymphocytes. To comprehend the contribution of HPV-specific T cells in this anti-tumor response we developed a method that allowed the analysis of the presence and specificity of cervix-infiltrating and draining lymph node resident T cells in a group of 74 patients with cervical malignancies, 54 of which were induced by HPV16 or HPV18. We detected the presence of HPV16 or HPV18-specific T cells in at least 23 of the 54 HPV-16 or -18 positive patients, and not in the 20 controls. Detailed studies resulted in the identification of 17 novel CD4+ and CD8+ T cell epitopes and their HLA-restriction elements, and also revealed that the HPV-specific immune response was aimed at both E6 and E7 and showed no preferential recognition of immunodominant regions. Unexpectedly, the vast majority of the CD4+ T cell epitopes were presented in the context of the less abundantly expressed HLA-DQ and HLA-DP molecules. Since the identified T cell epitopes constitute physiological targets in the immune response to HPV16 and HPV18 positive tumors they will be valuable for detailed studies on the interactions between the tumor and the immune system. This is crucial for the optimization of cancer immunotherapy in patients with pre-existing tumor-immunity.
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Affiliation(s)
- Sytse J Piersma
- Department of Clinical Oncology, Leiden University Medical Center, 2333 ZA, Leiden, The Netherlands
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Nedergaard BS, Ladekarl M, Nyengaard JR, Nielsen K. A comparative study of the cellular immune response in patients with stage IB cervical squamous cell carcinoma. Low numbers of several immune cell subtypes are strongly associated with relapse of disease within 5 years. Gynecol Oncol 2007; 108:106-11. [PMID: 17945335 DOI: 10.1016/j.ygyno.2007.08.089] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 08/20/2007] [Accepted: 08/29/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The purpose of this study was to investigate possible differences in the primary in situ cellular immune response between patients with and without relapse of Stage IB cervical squamous cell carcinoma. METHOD Paraffin-embedded tissue from 40 patients (20 with and 20 without relapse) was evaluated. Sections were immunostained for CD1a+, CD3+, CD4+, CD8+, CD20+, CD45RA+, CD45RO+, CD57+, CD68+ and GrB+ cells. Immune cell profile densities were estimated using stereology. RESULTS We found significantly lower densities of CD3+, CD4+, CD8+ and CD57+ cells (both intra- and peritumoral) in tissue from patients who had relapse. Also densities of intratumoral CD1a+ cells and peritumoral CD20+, CD45RA+ and CD45RO+ cells were significantly lower among patients with relapse. CONCLUSION This study demonstrates striking differences in the cellular immune response between patients with and without relapse within 5 years. The results are of potential value in adjuvant immunotherapy and prediction of prognosis.
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Low density of CD3+, CD4+ and CD8+ cells is associated with increased risk of relapse in squamous cell cervical cancer. Br J Cancer 2007; 97:1135-8. [PMID: 17940503 PMCID: PMC2360435 DOI: 10.1038/sj.bjc.6604001] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
The purpose of this study was to investigate the prognostic value of the primary in situ cellular immune response in cervical squamous cell carcinoma. A study of 102 women treated for stage IB and IIA disease, between 1990 and 2000, was performed. Paraffin-embedded cervical tissue processed at the time of diagnosis was immunostained for CD3+ (T cells), CD4+ (T helper/regulatory T cells) and CD8+ (cytotoxic T cells) cells. Immune cell profile densities were estimated using stereology. Both intra- and peritumoural cell densities were estimated. Using Cox's proportional hazards regression modelling we found an increase in cell density to decrease the risk of relapse for all three cell types. The density of peritumoural CD3+ cells seems to have the strongest potential for predicting relapse. An increase in CD3+ cell density from 795 to 2043 cells per mm2 (25–75 percentile) reduced the hazard ratio to 0.27.
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Fregnani JHTG, Soares FA, Novik PR, Lopes A, Latorre MDRDDO. Intensity of cervical inflammatory reaction as a risk factor for recurrence of carcinoma of the uterine cervix in stages IB and IIA. SAO PAULO MED J 2007; 125:231-6. [PMID: 17992395 PMCID: PMC11020539 DOI: 10.1590/s1516-31802007000400008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Revised: 12/04/2006] [Accepted: 06/19/2007] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE Inflammatory reaction intensity has been indicated as a possible recurrence risk factor in carcinoma of the uterine cervix. Some authors observed greater risk with weak inflammatory reaction, while others described the opposite. This study aimed to evaluate risk factors for initial-stage uterine cervix carcinoma recurrence (IB and IIA), considering inflammatory reaction intensity. DESIGN AND SETTING Retrospective cohort at Hospital do Câncer A. C. Camargo. METHODS 289 patients with diagnosed uterine cervix carcinoma (stages IB and IIA) who underwent radical surgery between 1980 and 1999 were studied. Data were collected from medical records. Histological sections from tumors and lymph nodes could be reviewed in 247 cases. Five-year disease-free survival rates were calculated using the Kaplan-Meier method and curves were compared using the log-rank test. Cox's proportional-hazards model was used for multivariate analysis. Recurrence risk was estimated using hazard ratios (HR). RESULTS Forty-three recurrences were found. Multivariate analysis identified the following independent recurrence risk factors: number of metastatic pelvic lymph nodes (one lymph node: HR = 3.3 [1.3-8.3]; two or three: HR = 5.3 [1.5-18.6]; four or more: HR = 7.6 [1.7-33.2]), tumor invasion depth (deepest third: HR = 2.1 [1.1-4.1]) and inflammatory reaction intensity in the uterine cervix (absent or slight: HR = 2.5 [1.1-5.7]). CONCLUSION This study identified that absent or slight inflammatory reaction was an independent risk factor for recurrence. The other risk factors were the number of metastatic pelvic lymph nodes and invasion of the deepest third of the uterine cervix.
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Abstract
Mounting effective anti-tumor immune responses against tumors by both the innate and adaptive immune effectors is important for the clearance of tumors. However, accumulated evidence indicates that immune responses that should otherwise suppress or eliminate transformed cells are themselves suppressed by the function of tumor cells in a variety of cancer patients, including those with oral cancers. Signaling abnormalities, spontaneous apoptosis, and reduced proliferation and function of circulating natural killer cells (NK), T-cells, dendritic cells (DC), and tumor-infiltrating lymphocytes (TILs) have been documented previously in oral cancer patients. Several mechanisms have been proposed for the functional deficiencies of tumor-associated immune cells in oral cancer patients. Both soluble factors and contact-mediated immunosuppression by the tumor cells have been implicated in the inhibition of immune cell function and the progression of tumors. More recently, elevated levels and function of key transcription factors in tumor cells, particularly NFkappaB and STAT3, have been shown to mediate immune suppression in the tumor microenvironment. This review will focus on these emerging mechanisms of immunosuppression in oral cancers.
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Affiliation(s)
- A Jewett
- The Jane and Jerry Weintraub Center for Reconstructive Biotechnology, Jonsson Comprehensive Cancer Center (JCCC), Department of Head and Neck Surgery, UCLA School of Dentistry and Medicine 90095-1688, USA.
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Piersma SJ, Jordanova ES, van Poelgeest MIE, Kwappenberg KMC, van der Hulst JM, Drijfhout JW, Melief CJM, Kenter GG, Fleuren GJ, Offringa R, van der Burg SH. High number of intraepithelial CD8+ tumor-infiltrating lymphocytes is associated with the absence of lymph node metastases in patients with large early-stage cervical cancer. Cancer Res 2007; 67:354-61. [PMID: 17210718 DOI: 10.1158/0008-5472.can-06-3388] [Citation(s) in RCA: 305] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a prospective study, we have examined the tumor-specific immune response in a group of 59 patients with human papillomavirus (HPV) 16-positive (HPV16(+))-induced or HPV18(+)-induced cervical cancer. Local antitumor immunity was analyzed by the enumeration of tumor-infiltrating dendritic cells and CD4+, CD8+, and regulatory T cells as well as by calculation of the ratio of CD8+/CD4+ T cells and CD8+/regulatory T cells. Systemic tumor-specific immunity was assessed by determination of the HPV E6- and/or E7-specific T-cell response in the blood of these patients. Finally, these variables were evaluated with respect to known histopathologic prognostic variables, including the absence (LN-) or presence (LN+) of lymph node metastases. Stratification according to the lymph node status of patients revealed a significantly stronger CD8+ T-cell tumor infiltration, a higher CD8+/CD4+ T-cell ratio, and higher CD8+/regulatory T-cell ratio in the group of patients in which the tumor failed to metastasize to the tumor-draining lymph node. Subdivision according to the presence (IR+) or absence (IR-) of circulating HPV-specific T cells disclosed that the highest number of tumor-infiltrating CD8+ T cells was found in the group of LN- patients displaying a concomitant systemic tumor-specific immune response (LN-IR+). CD8+ T-cell infiltration in LN-IR- patients was comparable with that of LN+ patients. In cervical cancer, the absence of lymph node metastases is strongly associated with a better prognosis. Our data indicate that, especially in a subgroup of LN- patients, a strong and effective interaction between immune system and tumor exists. This subgroup of cervical cancer patients may have the best prognosis.
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Affiliation(s)
- Sytse J Piersma
- Department of Clinical Oncology, Leiden University Medical Center, 2300 RC Leiden, the Netherlands
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Fregnani JHTG, Soares FA, Novik PR, Lopes A, Latorre MRDO. Comparison of biological behavior between early-stage adenocarcinoma and squamous cell carcinoma of the uterine cervix. Eur J Obstet Gynecol Reprod Biol 2006; 136:215-23. [PMID: 17125903 DOI: 10.1016/j.ejogrb.2006.10.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Revised: 08/11/2006] [Accepted: 10/20/2006] [Indexed: 12/12/2022]
Abstract
OBJECTIVES (1) To compare the anatomopathological variables and recurrence rates in patients with early-stage adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the uterine cervix; (2) to identify the independent risk factors for recurrence. STUDY DESIGN This historical cohort study assessed 238 patients with carcinoma of the uterine cervix (IB and IIA), who underwent radical hysterectomy with pelvic lymph node dissection between 1980 and 1999. Comparison of category variables between the two histological types was carried out using the Pearson's chi(2)-test or Fisher exact test. Disease-free survival rates for AC and SCC were calculated using the Kaplan-Meier method and the curves were compared using the log-rank test. The Cox proportional hazards model was used to identify the independent risk factors for recurrence. RESULTS There were 35 cases of AC (14.7%) and 203 of SCC (85.3%). AC presented lower histological grade than did SCC (grade 1: 68.6% versus 9.4%; p<0.001), lower rate of lymphovascular space involvement (25.7% versus 53.7%; p=0.002), lower rate of invasion into the middle or deep thirds of the uterine cervix (40.0% versus 80.8%; p<0.001) and lower rate of lymph node metastasis (2.9% versus 16.3%; p=0.036). Although the recurrence rate was lower for AC than for SCC (11.4% versus 15.8%), this difference was not statistically significant (p=0.509). Multivariate analysis identified three independent risk factors for recurrence: presence of metastases in the pelvic lymph nodes, invasion of the deep third of the uterine cervix and absence of or slight inflammatory reaction in the cervix. When these variables were adjusted for the histological type and radiotherapy status, they remained in the model as independent risk factors. CONCLUSION The AC group showed less aggressive histological behavior than did the SCC group, but no difference in the disease-free survival rates was noted.
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Affiliation(s)
- José H T G Fregnani
- Morphology Department of the School of Medical Sciences of Santa Casa de São Paulo, Rua Dr. Cesário Motta Júnior, 61, CEP 01221-020 São Paulo, Brazil.
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Ashour AE, Turnquist HR, Singh RK, Talmadge JE, Solheim JC. CCL21-induced immune cell infiltration. Int Immunopharmacol 2006; 7:272-6. [PMID: 17178395 DOI: 10.1016/j.intimp.2006.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
Cellular immune responses can be initiated via peptide presentation by specialized antigen presenting cells, dendritic cells (DCs), which stimulate naïve T cells. The trafficking of DCs and T cells is regulated by chemokines such as CCL21. CCL21 is normally expressed in the lymphoid organs and coordinates the interactions between DCs and T cells, thereby contributing to the initiation of T cell responses. In order to comprehend the mechanisms of CCL21 activity and to utilize CCL21 optimally in therapy, understanding the kinetics of the responses of various cell types to CCL21 would be beneficial. Therefore, in this study, we injected mice subcutaneously (s.c.) with CCL21 and examined the DC and T cell infiltration of the local draining lymph node. CCL21 injection resulted in significantly increased numbers of lymphoid and myeloid DCs and effector T lymphocytes in the local node at 4 days. Furthermore, at 4 days small lymphoid-like structures were visible in the injection areas. These results provide guidance for the optimal timing of CCL21 use in combination with vaccines.
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Affiliation(s)
- Abdelkader E Ashour
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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38
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Cai XY, Gao Q, Qiu SJ, Ye SL, Wu ZQ, Fan J, Tang ZY. Dendritic cell infiltration and prognosis of human hepatocellular carcinoma. J Cancer Res Clin Oncol 2006; 132:293-301. [PMID: 16421755 DOI: 10.1007/s00432-006-0075-y] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 12/05/2005] [Indexed: 02/08/2023]
Abstract
AIM To elucidate the relationship between local immunocompetent cells and prognosis of human hepatocellular carcinoma (HCC) after resection. METHODS HE staining and immunohistochemical study were carried out on specimens from patients underwent surgical resection. Local immunocompetent cells, such as dendritic cells (DCs), memory T cells, CD3+ T lymphocytes and CD8+ T lymphocytes, were counted and their relationships with tumor-free survival rate were analyzed by grouping DCs with the T lymphocytes retrospectively. RESULTS The number grade of infiltrating immunocompetent cells in HCC nodules and pericancerous tissues under HE staining had no significant correlation with tumor-free survival time (P=0.054, 0.071, respectively). DCs were mainly among tumor cells, encircling tumor cells with their pseudopodia and were in contact with T lymphocytes. A certain number of DCs in HCC nodules (> or =25/10HPF) statistically correlated to tumor-free survival time (P=0.005), while a certain number of DCs in pericancerous tissues (> or =28/10HPF) had no correlation with tumor-free survival time (P=0.329). The number of memory T cells, CD3+ T lymphocytes and CD8+ T lymphocytes in HCC nodules strongly correlated to tumor-free survival time (P=0.003, 0.005, 0.037, respectively). The tumor-free survival rate curves revealed that the more DCs or together with memory T cells/CD3+ T lymphocytes or that the more CD8+ T lymphocytes were detected in HCC nodules, the better the prognosis would be. CONCLUSIONS Marked infiltration of DCs in HCC nodules was closely related to the prognosis of HCC after surgical resection and can be served as a predictive index for recurrence and metastasis of HCC.
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Affiliation(s)
- Xiao-Yan Cai
- Liver Cancer Institute and Zhong Shan Hospital, Fudan University, 200032, Shanghai, People's Republic of China
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39
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Coventry BJ, Morton J. CD1a-positive infiltrating-dendritic cell density and 5-year survival from human breast cancer. Br J Cancer 2003; 89:533-8. [PMID: 12888826 PMCID: PMC2394362 DOI: 10.1038/sj.bjc.6601114] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Infiltrating CD1a(+) dendritic cells (DCs) have been associated with increased survival in a number of human cancers. This study investigated DC infiltration within breast cancers and the association with survival. Classical established prognostic factors, of tumour size, lymph node status, histological grade, lympho-vascular invasion, the KI-67 (MIB-1) fraction and the Nottingham Prognostic Index (NPI) were also compared. A total of 48 breast cancer patients were followed from the time of surgery and CD1a density analysis for 5 years or until death. Our data set validated previous studies, which show a relationship between survival and the NPI (P<0.001), tumour size (P<0.01) and lymph node status (P<0.05). Although more patients were alive at the 5-year time point in the group with higher CD1a DC density than the lower CD1a DC group, this failed to reach statistical significance at the P=0.05 level. Analysis at 10 years postsurgery is required to investigate the association further.
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Affiliation(s)
- B J Coventry
- Breast, Endocrine and Surgical Oncology Unit and Tumour Immunology Laboratory, Department of Surgery, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia.
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40
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Günther K, Radkow T, Reymond MA, Pflüger R, Dimmler A, Hohenberger W, Papadopoulos T. Angiogenesis and dendritic cell density are not correlated with metachronous distant metastasis in curatively operated rectal cancer. Int J Colorectal Dis 2003; 18:300-8. [PMID: 12774244 DOI: 10.1007/s00384-002-0470-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2002] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Apart from surgery, treatment of rectal cancer increasingly involves the use of (neo-)adjuvant strategies. To optimize the selection process for these therapy regimens, especially in the field of cellular and molecular biology, new prognostic factors additional to the established TNM system are being investigated. PATIENTS AND METHODS Two groups of patients ( n=2x85) with rectal carcinoma curatively treated by surgery alone were studied retrospectively (median follow-up 6.1 years). To exclude the effect of the surgeon only patients free of locally recurrent disease were selected. Patient groups were matched for age, gender, UICC stage, and year of operation (1982-1991) and differed only in subsequent metachronous distant metastatic spread, i.e., the criterion to be studied. The factors investigated in uni- and multivariate analysis were angiogenesis, density of dendritic cells, grading, venous invasion, and lymphatic invasion. RESULTS Grading invariably proved to be the only significant prognostic factor. In univariate analysis the absence of venous invasion was also correlated significantly with increased disease-free survival. CONCLUSION Angiogenesis and dendritic cell density are not prognostic factors for metachronous distant metastasis in rectal cancer and therefore cannot serve as selection parameters for adjuvant therapy.
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Affiliation(s)
- K Günther
- Department of Surgery, University of Erlangen, Krankenhausstrasse 12, 91054, Erlangen, Germany.
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41
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Yamazawa K, Matsui H, Ishikura H, Seki K, Mitsuhashi A, Sekiya S. Significance of perivascular lymphocytic infiltrates on survival of patients with invasive cervical cancer. J Immunother 2003; 26:149-55. [PMID: 12616106 DOI: 10.1097/00002371-200303000-00007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors retrospectively reviewed the medical records of 129 patients with stage IB and II cervical cancer (93 squamous cell carcinomas, 30 adenocarcinomas, and 6 adenosquamous carcinomas) who underwent primary surgery between 1989 and 2000. Vascular invasion is the predictor of recurrence, and lymphocytic infiltrates within the tumor is associated with favorable outcome in cervical cancer. Hence, 129 patients were divided into three groups according to the presence or absence of vascular invasion (VI) and perivascular lymphocytic infiltrates (PLI); VI- (n = 77), VI+PLI- (n = 26), and VI+PLI+ (n = 26), to evaluate the significance of PLI. Age, clinical stage, histology, tumor grade, depth of stromal invasion, VI and PLI, tumor size, ovarian metastasis, pelvic lymph node metastasis, postoperative irradiation, and chemotherapy were assessed statistically for recurrence of the disease by Cox regression analysis. Disease-free survival was analyzed using Kaplan-Meier survival analysis. Recurrence was observed in 32 (25%) of all 129 cases. In a multivariate analysis, VI ( = 0.003) and histology ( = 0.006) remained significantly associated with recurrence. When divided into three groups, the hazard ratio for recurrence was higher in the absence of PLI (2.95 in VI+PLI- group versus 2.07 in VI+PLI+ group), and value became significant in the absence of PLI (0.008 in VI+PLI- group versus 0.106 in VI+PLI+ group). In Kaplan-Meier survival analysis, only the VI+PLI- group ( = 0.006) was significantly associated with worse survival compared with the VI- group. These results suggest that the coexistence of perivascular lymphocytic infiltrates is associated with a better prognosis in cases with vascular invasion.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adult
- Aged
- Biopsy, Needle
- Carcinoma, Adenosquamous/mortality
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Adenosquamous/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/surgery
- Disease-Free Survival
- Female
- Humans
- Hysterectomy/methods
- Immunohistochemistry
- Japan
- Lymph Node Excision
- Lymphatic Metastasis/pathology
- Middle Aged
- Multivariate Analysis
- Neoplasm Invasiveness/pathology
- Neoplasm Recurrence, Local/mortality
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/surgery
- Probability
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Survival Analysis
- Uterine Cervical Neoplasms/mortality
- Uterine Cervical Neoplasms/pathology
- Uterine Cervical Neoplasms/surgery
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Affiliation(s)
- Koji Yamazawa
- Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Japan.
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42
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Dallal RM, Christakos P, Lee K, Egawa S, Son YI, Lotze MT. Paucity of dendritic cells in pancreatic cancer. Surgery 2002; 131:135-8. [PMID: 11854690 DOI: 10.1067/msy.2002.119937] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The number of dendritic cells (DC) in the local tumor environment correlates with patient survival in numerous tumors. The relationship of DC infiltration in the tumor microenvironment and prognosis was examined in patients with pancreatic adenocarcinoma. METHODS Forty-seven pancreatectomy specimens with a diagnosis of pancreatic adenocarcinoma were identified retrospectively and analyzed with the dendritic cell markers S-100 and CD1a. Patient survival was correlated with these markers and with p53, CD3, CD20, CD68, Ki-67. RESULTS Significant numbers (>3 per high-powered field) of tumor-associated S100(+) or CD1a(+) cells were found in only 2/47 patients (4%). When present, dendritic cells were located outside the margin of the tumor. CD3, CD68, and CD20 positive cells were rare or absent in 96%, 92%, and 93% of the specimens. A correlation with survival and numbers of immune cells could not be made secondary to their rarity. The median survival was 18.9 months. No other indices measured correlated with survival. CONCLUSIONS In patients with pancreatic adenocarcinoma, there is a paucity of immune cells within the tumor.
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Affiliation(s)
- Ramsey M Dallal
- Department of Surgery and Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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43
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Kobayashi A, Darragh T, Herndier B, Anastos K, Minkoff H, Cohen M, Young M, Levine A, Grant LA, Hyun W, Weinberg V, Greenblatt R, Smith-McCune K. Lymphoid follicles are generated in high-grade cervical dysplasia and have differing characteristics depending on HIV status. THE AMERICAN JOURNAL OF PATHOLOGY 2002; 160:151-64. [PMID: 11786409 PMCID: PMC1867118 DOI: 10.1016/s0002-9440(10)64359-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The exact role of the mucosal immune response in the pathogenesis of human papillomavirus (HPV)-related premalignant and malignant diseases of the genital tract is poorly understood. We used immunohistochemical analysis to characterize immune cells in normal cervix (N = 21), HIV-negative high-grade dysplasia (N = 21), and HIV-positive high-grade dysplasia (N = 30). Classical germinal centers were present in 4.7% of normal cervix, 33% of high-grade lesions from HIV-negative women, and 3.3% of high-grade lesions from HIV-positive women (P = 0.003). HPV16 E7 antigen was detected in a subset of germinal centers, indicating that the secondary immune response was directed in part against HPV. Lymphoid follicles were present in 9.5% of normal cervix, 57% of HIV-negative high-grade dysplasia, and 50% of HIV-positive high-grade dysplasia (P = 0.001 normal versus high-grade). A novel type of lymphoid aggregate, consisting predominantly of CD8(+) T cells, was detected in 4.8% of normal cervix, 0% of HIV-negative high-grade dysplasia, and 40% of HIV-positive high-grade dysplasia (P < 0.001). The recurrence rate of high-grade dysplasia within one year was significantly higher in women with such CD8(+) T cell-dominant aggregates (P = 0.02). In summary, the types of lymphoid follicle in lesions from HIV-positive women were significantly different from those from HIV-negative women, and these differences are associated with the worse clinical outcome in HIV-positive women.
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Affiliation(s)
- Akiko Kobayashi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California at San Francisco, San Francisco, California 94143-0128, USA
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44
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Abstract
Researchers and clinicians have tried for decades to use the mechanisms of immunity for the fight against cancer. Early attempts aimed at the instrumentation of soluble immune mediators such as antibodies or cytotoxic proteins for the therapy of malignancies. Major improvements in understanding the induction and regulation of cellular immunity have now made it possible to generate effector cells in cancer patients which are specific for the neoplastic disease. At the beginning of every cellular immune reaction against cancers tumor antigens have to be presented to T cells in order to activate them and drive them into clonal expansion. This is done by antigen presenting cells, the most powerful of which is the dendritic cell (DC). While DC were hard to isolate initially, they can be generated in large numbers in vitro today and manipulated in multiple ways before given back to a patient to induce tumor immunity. Thus, a great amount of hope lies in the use of DC as inducers of tumor immunity. However, the first clinical studies, which have now been completed with only limited success make clear, that still a lot of open questions remain to be answered. This review tries to give an overview of this rapidly developing field, mentioning the major conceptual approaches and techniques, but also discussing important caveats. The next years will show whether we can improve our understanding of DC biology and the mechanisms of immune induction strongly enough to effectively employ DC for immunotherapy of cancer.
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Affiliation(s)
- M Gunzer
- Department of Dermatology, University of Münster, Von-Esmarch-Str 58, D-48149 Münster, Germany
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45
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Eisenthal A, Polyvkin N, Bramante-Schreiber L, Misonznik F, Hassner A, Lifschitz-Mercer B. Expression of dendritic cells in ovarian tumors correlates with clinical outcome in patients with ovarian cancer. Hum Pathol 2001; 32:803-7. [PMID: 11521223 DOI: 10.1053/hupa.2001.26455] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dendritic cells (DCs) are the most potent antigen-presenting cells and are thought to reflect the interaction between the host immune system and tumor cells. In a retrospective study, we analyzed the presence of DCs and memory lymphocytes in tumor biopsy specimens of 18 patients with ovarian cancer. These patients were followed up for 10 to 37 months. Within this period, 9 patients had no evidence of disease (NED, group A), and 9 patients had recurrence (group B). In group A, 5 cases were stage III, 1 was stage I, and 1 was stage II. In group B, 5 cases were stage III, 1 was stage III-IV, and 3 were stage IV. Our results show that the mean number of cells expressing the DC phenotype, HLA-DR(+) CD1a(+), in tumor biopsies was substantially higher in group A than in group B (HLA-DR(+): 37.8 +/- 18.2 v. 10.7 +/- 2.2, respectively; P <.005; CD1a(+): 9.5 +/- 11.3 v 2.1 +/- 3.7). On the other hand, the number of cells expressing the DC phenotype S-100 protein was substantially lower in group A than in group B (S-100(+): 9.7 +/- 9.9 v 16.2 +/- 12.7), although the difference was not statistically significant. There was no difference in the number of tumor-infiltrating CD45RO(+) cells between groups A and B (CD45RO(+): 39.1 +/- 28.5 v 34.2 +/- 19.1). Our results show that the presence of relatively high numbers of defined DC subpopulations may have prognostic value in ovarian tumors.
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Affiliation(s)
- A Eisenthal
- Pathology Institute, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
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46
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van der Burg SH, Kwappenberg KM, O'Neill T, Brandt RM, Melief CJ, Hickling JK, Offringa R. Pre-clinical safety and efficacy of TA-CIN, a recombinant HPV16 L2E6E7 fusion protein vaccine, in homologous and heterologous prime-boost regimens. Vaccine 2001; 19:3652-60. [PMID: 11395199 DOI: 10.1016/s0264-410x(01)00086-x] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Human papillomavirus (HPV) E6 and E7 oncoproteins are attractive targets for T-cell-based immunotherapy of cervical intraepithelial neoplasia (CIN) and cancer. A newly designed vaccine, comprising the HPV16 L2, E6 and E7 as a single fusion protein (TA-CIN), was shown to elicit HPV16-specific CTL, T-helper cells and antibodies in a pre-clinical mouse model. These immune responses effectively prevented outgrowth of HPV16-positive tumour cells in a prophylactic setting as well as in a minimal residual disease setting. CTL immunity was optimally induced when TA-CIN was employed in heterologous prime-boost regimens in combination with TA-HPV, a clinical grade vaccinia-based vaccine. These data provide a scientific basis for the use of TA-CIN, alone or in combination with TA-HPV in future human trials.
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MESH Headings
- Animals
- Antigens, Neoplasm/administration & dosage
- Antigens, Neoplasm/immunology
- Antigens, Neoplasm/therapeutic use
- Antigens, Neoplasm/toxicity
- Antigens, Viral/administration & dosage
- Antigens, Viral/immunology
- Antigens, Viral/therapeutic use
- Antigens, Viral/toxicity
- Cancer Vaccines/administration & dosage
- Cancer Vaccines/immunology
- Cancer Vaccines/therapeutic use
- Cancer Vaccines/toxicity
- Capsid/administration & dosage
- Capsid/immunology
- Capsid/therapeutic use
- Capsid/toxicity
- Capsid Proteins
- Cell Line
- Cell Line, Transformed
- Drug Evaluation, Preclinical
- Immunotherapy
- Mice
- Mice, Inbred C57BL
- Oncogene Proteins, Viral/administration & dosage
- Oncogene Proteins, Viral/immunology
- Oncogene Proteins, Viral/therapeutic use
- Oncogene Proteins, Viral/toxicity
- Papillomaviridae/immunology
- Papillomavirus E7 Proteins
- Recombinant Fusion Proteins/administration & dosage
- Recombinant Fusion Proteins/immunology
- Recombinant Fusion Proteins/therapeutic use
- Recombinant Fusion Proteins/toxicity
- Vaccines, Acellular/administration & dosage
- Vaccines, Acellular/immunology
- Vaccines, Acellular/therapeutic use
- Vaccines, Acellular/toxicity
- Uterine Cervical Dysplasia/prevention & control
- Uterine Cervical Dysplasia/therapy
- Uterine Cervical Dysplasia/virology
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Affiliation(s)
- S H van der Burg
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Building 1, E3-Q, PO Box 9600, 2300 RC Leiden, The Netherlands.
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47
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Birner P, Schindl M, Obermair A, Breitenecker G, Kowalski H, Oberhuber G. Lymphatic microvessel density as a novel prognostic factor in early-stage invasive cervical cancer. Int J Cancer 2001; 95:29-33. [PMID: 11241307 DOI: 10.1002/1097-0215(20010120)95:1<29::aid-ijc1005>3.0.co;2-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Few data on the influence of lymphatic microvessel density (MVD) on survival in cancer are available since until recently there was no reliable immunohistological marker for lymphatic endothelium. Using an antibody staining podoplanin, a novel marker for lymphatic endothelium, lymphatic MVD in tissue samples of 85 patients with cervical cancer classification pT1b treated by radical hysterectomy was investigated. Survival was determined using univariate and multivariate analyses. Lymphatic MVD was also compared to MVD assessed by immunostaining against factor VIII-related antigen, which is considered a marker for blood vessels. Patients with >5 lymphatic microvessels/0.25 mm(2) field had significantly better overall survival (mean 91.8 months) than those with < or =5 lymphatic microvessels/field in univariate analysis (mean 113 months) (p = 0.0105, log-rank test). In multivariate analysis, lymphatic node involvement (p =0.0183), vessel infiltration (p =0.0158) and lymphatic MVD (p =0.0269) remained independent prognostic factors. No correlation between lymphatic MVD and various clinical and histopathological parameters was observed. Correlation between lymphatic MVD and MVD assessed by immunostaining against factor VIII was only weak (p = 0.004, r = 0.312, Spearman's coefficient of correlation). Our results suggest that increased lymphatic MVD is associated with favorable prognosis in early-stage cervical cancer.
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Affiliation(s)
- P Birner
- Institute of Clinical Pathology, University of Vienna, Vienna, Austria.
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48
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Ishigami S, Natsugoe S, Tokuda K, Nakajo A, Xiangming C, Iwashige H, Aridome K, Hokita S, Aikou T. Clinical impact of intratumoral natural killer cell and dendritic cell infiltration in gastric cancer. Cancer Lett 2000; 159:103-8. [PMID: 10974412 DOI: 10.1016/s0304-3835(00)00542-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Intratumoral natural killer cells (NKC) and dendritic cells (DC) may affect the clinical features of various gastrointestinal cancers. However, the relationship between intratumoral NKC and DC remains unclear. We examined 169 patients with gastric cancer who underwent gastrectomy at Kagoshima University Hospital. Immunohistochemical staining of CD57 and S-100-protein was performed to evaluate NKC and DC infiltration, respectively. A total of 25 areas containing pericancerous tissue were selected for determining the number of NKC and DC under high power microscopy (x400). Patients were classified into two groups according to NKC and DC population. Intratumoral lymphocytic infiltration was also calculated in 15 areas with a high power (x400) objective. The degree of NKC and DC infiltration was gradually decreased according to the progression of nodal involvement. Patients with many NKC infiltration had a lower positivity of lymph node metastasis and lymphatic invasion than patients with little NKC infiltration. DC infiltration was also negatively correlated with depth of invasion, lymph node metastasis and curativity. DC infiltration was positively correlated with lymphocytic infiltration (P=0.01. r=0.6). The 5-year survival rates of patients with many NKC infiltration and patients with DC many infiltration were 75 and 78%, respectively, both of which were significantly better than that of patients with little NKC and DC infiltration (P<0.05). NKC may be activated without DC or intratumoral lymphocytes. Intratumoral NKC may act as an independent immunologic effector against tumor cells, unlike DC.
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Affiliation(s)
- S Ishigami
- First Department of Surgery, Kagoshima University School of Medicine, 8-35-1 Sakuragaoka, 890-8520, Kagoshima, Japan.
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49
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Tang W, Wang X, Utsunomiya H, Nakamuta Y, Yang Q, Zhang Q, Zhou G, Tsubota Y, Mabuchi Y, Li L, Kakudo K. Thymidine phosphorylase expression in tumor stroma of uterine cervical carcinomas: histological features and microvessel density. Cancer Lett 2000; 148:153-9. [PMID: 10695991 DOI: 10.1016/s0304-3835(99)00326-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Immunohistochemical staining was performed on 91 cases of uterine neoplasm in order to determine if expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase (TP) correlates with tumor microvessel density (MVD) and histological parameters of uterine carcinomas in tumor cells and in tumor stroma. The sample group consisted of 72 primary invasive squamous cell carcinomas of the cervix (ISC) and 19 cervical intraepithelial neoplasms (CIN) of the uterus. In ISC of the cervix, TP expression in tumor stroma showed a significant correlation with a non-keratinizing histological subtype (P < 0.001) and with an infiltrating invasive pattern (P < 0.001). However, in tumor cells the TP expression showed a higher correlation with a keratinizing histological subtypes (P = 0.009). MVD was significantly higher (P = 0.002) in tumors showing high TP expression in stroma than in tumors with low expression. These findings suggest that the TP expression in stromal cells, rather than in tumor cells, may play a role in promoting microvessel growth in cervical squamous cell carcinoma, and angiogenesis may also have an association with tumor cell invasion.
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Affiliation(s)
- W Tang
- The Second Department of Pathology, Wakayama Medical College, Wakayama City, Japan
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50
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Lespagnard L, Gancberg D, Rouas G, Leclercq G, de Saint-Aubain Somerhausen N, Di Leo A, Piccart M, Verhest A, Larsimont D. Tumor-infiltrating dendritic cells in adenocarcinomas of the breast: a study of 143 neoplasms with a correlation to usual prognostic factors and to clinical outcome. Int J Cancer 1999; 84:309-14. [PMID: 10371352 DOI: 10.1002/(sici)1097-0215(19990621)84:3<309::aid-ijc19>3.0.co;2-3] [Citation(s) in RCA: 92] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Dendritic cells (DC) are the most potent antigen-presenting cells, and induce antigen-specific immune responses. Infiltration of tumors by DC is thought to reflect the interaction between the host immune system and tumor cells. Tumor-infiltrating DC (TIDC) are believed to evolve into tumor-antigen pulsed cells and then to migrate to local lymph nodes, where they activate anti-tumor immune responses. Indirect clinical evidence supporting this theory is provided by studies showing that high TIDC densities are associated with favorable prognosis in some tumor types. In the present study, we evaluated 143 primary breast adenocarcinomas for the presence of DC, using immunohistochemistry with the anti-S100 protein antibody. We analyzed the relationship between the degree of infiltration by S100+ TIDC and the usual prognostic factors and clinical outcome. The results show that 42% of breast adenocarcinomas contain S100 TIDC. The number of S100+ TIDC varies according to the grade of tumors as follows: GRIII > GRII > GRI. A relationship is also found between S100+ TIDC and tumor size, lymph-node involvement, estrogen/progesterone receptor status and age. However, the presence of S100+ TIDC, even at the highest density, was not correlated with metastasis-free survival or overall survival.
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Affiliation(s)
- L Lespagnard
- Département d'Anatomie Pathologique, Institut Jules Bordet, Brussels, Belgium
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