Prognostic Impact and Utility of Immunoprofiling in the Selection of Patients with Colorectal Peritoneal Carcinomatosis for Cytoreductive Surgery (CRS) and Heated Intraperitoneal Chemotherapy (HIPEC)

Mary Garland-Kledzik, Abhineet Uppal, Yalda B. Naeini, Stacey Stern, Richard Erali, Anthony J. Scholer, Adam M. Khader, Juan A. Santamaria-Barria, Kathleen Cummins-Perry, Yi Zhou, Konstantinos I. Votanopoulos, Perry Shen, Edward A. Levine, Anton J. Bilchik

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: Recent studies have shown an association in non-metastatic colorectal cancer between patient survival and immunoprofiling (expression of CD3, CD4, CD8, CD45, and FOXP3 T cells at the invasive margin (IM) and the tumor center (TC)) regardless of stage. Patients with peritoneal carcinomatosis have a dismal prognosis, but survival can be significantly improved in selected patients who undergo cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). However, current patient selection for CRS/HIPEC is suboptimal. The purpose of this study is to evaluate immune profiles of patients with peritoneal carcinomatosis and their correlation with overall survival (OS). Methods: The study cohort included patients from a prospectively maintained database of adults with colorectal peritoneal carcinomatosis who underwent CRS/HIPEC. Immunohistochemistry (IHC) using antibodies to CD3, CD4, CD8, CD45RO, and FOXP3 T cells was performed. IHC image density was calculated using ImageJ software, and an immunoscore was determined. Results: Eighty tumors were evaluated from 66 patients. These included 14 primary sites and 66 metastatic sites. R0/R1 resection was achieved in 44 (66.7%) patients. Known prognostic factors including resection status (HR 1.99, p = 0.004) and lymph node status (HR 3.49, p = 0.002) were associated with overall survival. On multivariate analysis, increased CD3/CD4 IM (HR 0.54, p = 0.03) ratio positively was associated with improved OS. Discussion: This is the first study to assess the utility of subtypes of T cells as prognostic markers in patients with colorectal peritoneal carcinomatosis, which may play a role in patients with low-volume disease. Further studies into immune mechanisms may improve patient selection for cytoreductive surgery and HIPEC as well as provide novel pathways for effective immunotherapy.

Original languageEnglish (US)
Pages (from-to)233-240
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume25
Issue number1
DOIs
StatePublished - Jan 2021
Externally publishedYes

Keywords

  • HIPEC
  • Immune profiling
  • Peritoneal carcinomatosis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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