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Correspondence |

The Immune Score as a Further Prognostic Indicator in Carcinoid Tumors FREE TO VIEW

Luca Roncati, MD, PhD; Antonio Manenti, MD, PhD; Francesco Piscioli, MD, PhD; Teresa Pusiol, MD, PhD; Giuseppe Barbolini, MD, PhD
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the Italian Research Program of Emilia Romagna Region for the University of Modena and Reggio Emilia (CUP E35E09000880002).

FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

aDepartment of Diagnostic and Clinical Medicine and of Public Health, Division of Pathology, University of Modena and Reggio Emilia, Modena, Italy

bDepartment of Medical and Surgical Sciences, Division of Surgery, University of Modena and Reggio Emilia, Modena, Italy

cProvincial Health Care Services, Santa Maria del Carmine Hospital, Institute of Pathology, Rovereto, Italy

CORRESPONDENCE TO: Luca Roncati, MD, PhD, Department of Diagnostic and Clinical Medicine and of Public Health, Division of Pathology, University of Modena and Reggio Emilia, Policlinico Hospital, I-41124 Modena (MO), Italy


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(5):1186. doi:10.1016/j.chest.2016.10.032
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A substantial body of research suggests that the development of cancer is also influenced by the host immune system, underlying the importance of immunologic biomarkers in predicting prognosis and response to therapy.,, Thus, incorporating the immune score as a prognostic factor and introducing it into routine diagnostic assessment is indicated. The urgent need to agree to a standard laboratory protocol is underlined by the inherent complexity of quantitative immunohistochemistry, in conjunction with other variable factors—for example, the types of immune cells analyzed, regional selection criteria, and differences in quantifying immune infiltration. We read with great interest the paper by Wolin, in which the author highlights a marked correlation between tumor prognosis, histologic grade, and disease stage. In strict compliance with World Health Organization criteria, we analyzed 45 surgical specimens (29 lung, 12 midgut, four pancreas) of well-differentiated (grade 1) neuroendocrine carcinoid tumors. We found that a “brisk” tumor lymphocytic infiltrate correlates with a good prognosis, being the expression of an immunologic reaction to the neoplastic cells. Conversely, a “nonbrisk” or absent infiltrate represents a form of immune tolerance to the tumor, favoring its metastatic spread., The quantitative immune score can thus be considered a prognostic indicator to complement histologic grade in cases of carcinoid tumors. Everolimus is currently the only agent approved for their treatment. We would strongly advocate in the not to distant future the adoption of a modulated therapeutic approach in which the immune score is an integral part of the diagnostic protocol.

References

Galon J. .Mlecnik B. .Bindea G. .et al Towards the introduction of the ‘Immunoscore' in the classification of malignant tumours. J Pathol. 2014;232:199-209 [PubMed]journal. [CrossRef] [PubMed]
 
Roncati L. .Barbolini G. .Piacentini F. .Piscioli F. .Pusiol T. .Maiorana A. . Prognostic factors for breast cancer: an immunomorphological update. Pathol Oncol Res. 2016;22:449-452 [PubMed]journal. [CrossRef] [PubMed]
 
Manenti A. .Roncati L. .Sighinolfi P. .Barbolini G. . Absence of immune response as a sign of tissue tolerance in small-cell lung cancer. Gene Cell Tissue. 2014;1:e20330- [PubMed]journal
 
Wolin E.M. . Advances in the diagnosis and management of well-differentiated and intermediate-differentiated neuroendocrine tumors of the lung. Chest. 2017;151:1141-1146 [PubMed]journal
 
Roncati L. .Manenti A. .Farinetti A. .Pusiol T. . The association between tumor-infiltrating lymphocytes (TILs) and metastatic course in neuroendocrine neoplasms. Surgery. 2016;160:1709- [PubMed]journal
 
Roncati L. .Manenti A. .Pusiol T. .Piscioli F. .Barbolini G. . The lymphocytic inflammation correlates with metastatic risk in carcinoid tumors. Inflamm Cell Signal. 2015;2:e1049- [PubMed]journal
 

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References

Galon J. .Mlecnik B. .Bindea G. .et al Towards the introduction of the ‘Immunoscore' in the classification of malignant tumours. J Pathol. 2014;232:199-209 [PubMed]journal. [CrossRef] [PubMed]
 
Roncati L. .Barbolini G. .Piacentini F. .Piscioli F. .Pusiol T. .Maiorana A. . Prognostic factors for breast cancer: an immunomorphological update. Pathol Oncol Res. 2016;22:449-452 [PubMed]journal. [CrossRef] [PubMed]
 
Manenti A. .Roncati L. .Sighinolfi P. .Barbolini G. . Absence of immune response as a sign of tissue tolerance in small-cell lung cancer. Gene Cell Tissue. 2014;1:e20330- [PubMed]journal
 
Wolin E.M. . Advances in the diagnosis and management of well-differentiated and intermediate-differentiated neuroendocrine tumors of the lung. Chest. 2017;151:1141-1146 [PubMed]journal
 
Roncati L. .Manenti A. .Farinetti A. .Pusiol T. . The association between tumor-infiltrating lymphocytes (TILs) and metastatic course in neuroendocrine neoplasms. Surgery. 2016;160:1709- [PubMed]journal
 
Roncati L. .Manenti A. .Pusiol T. .Piscioli F. .Barbolini G. . The lymphocytic inflammation correlates with metastatic risk in carcinoid tumors. Inflamm Cell Signal. 2015;2:e1049- [PubMed]journal
 
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