Hubungan antara Tumor-Infiltrating Lymphocytes dengan Stadium dan Derajat Diferensiasi Adenokarsinoma Kolorektal
DOI:
https://doi.org/10.35790/msj.v6i1.48480Abstract
Abstract: Colorectal cancer has high incidence and mortality rates. Tumor-infiltrating lymphocytes (TILs) are histopathological findings that depict the individual's immune response to the tumor. This study aimed to investigate the relationship between TILs and the differentiation grade and stage of colorectal adenocarcinoma. This was an analytical and observational study with a cross-sectional design. The results showed 34 patients with colorectal adenocarcinoma who met the criteria. The sample characteristics consisted of male (64.7%), mean age (59.15 ± 10.78), tumor location in the colon (43.9%) and rectum (55.8%), average TILs (25.62 ± 17.39), moderate TILs grade (50%), stage III tumor (50%), and moderately differentiated tumors (70.6%). A significant association was found between TILs and tumor differentiation grade (p=0.024). Post hoc analysis showed a significant difference in TILs between good and poor differentiation (p=0.04; 95% CI: 1.52-64.48). A cut-off value for TILs was identified for good differentiation (TIL>27) and moderate/poor differentiation (TIL≤27) with a sensitivity of 69.2% and specificity of 75.0%. The extent of lymphocytic invasion of tumor tissue reflected the host's immune status. TILs played an important role in tumor development and was a good prognostic factor in colorectal cancer. In conclusion, TILs can be used as a predictor for the differentiation grade of colorectal adenocarcinoma.
Keywords: colorectal adenocarcinoma; tumor infiltrating lymphocytes; differentiation grade
Abstrak: Kanker kolorektal memiliki angka kejadian dan mortalitas tinggi. Tumor-infiltrating lymphocytes (TILs) merupakan temuan histopatologik yang menggambarkan respon imunologis individu terhadap tumor. Penelitian ini bertujuan untuk mengetahui hubungan antara TILs dengan derajat diferensiasi dan stadium pada adenokarsinoma kolorektal. Jenis penelitian ialah analitik observasional dengan desain potong lintang. Hasil penelitian mendapatkan 34 pasien dengan adenokarsinoma kolorektal yang memenuhi kriteria. Karakteristik sampel terbanyak ialah jenis kelamin laki-laki (64,7%), rerata usia (59,15 ± 10,78), lokasi tumor di kolon (43,9%) dan rektum (55,8%), rerata TILs (25,62 ± 17,39), derajat TILs moderate (50%), stadium tumor derajat III (50%) dan derajat diferensiasi tumor sedang (70,6%). Terdapat hubungan bermakna TILs dengan derajat diferensiasi tumor (p=0,024). Analisis post hoc bermakna terhadap derajat TILs baik vs buruk (p=0,04; 95% CI: 1.52-64.48). Nilai cut-off TILs dengan derajat diferensiasi baik (TIL>27) dan sedang/buruk (TIL≤27) dengan sensitivitas 69,2% dan spesifisitas 75,0%. Luasnya invasi limfositik pada jaringan tumor mencerminkan status kekebalan tubuh pejamu. TILs berperan penting dalam perkembangan tumor dan merupakan faktor prognostik yang baik pada kanker kolorektal. Simpulan penelitian ini ialah nilai TILs dapat digunakan sebagai faktor prediktor derajat diferensiasi adenokarsinoma kolorektal.
Kata kunci: adenokarsinoma kolorektal; tumor infliltrating lymphocytes; derajat diferensiasi
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. Doi: 10.3322/caac.21660.
Fleming M, Ravula S, Tatishchev SF, Wang HL. Colorectal carcinoma: pathologic aspects. Journal of Gastrointestinal Oncology (JGO). 2012;3(3):153–73. Available from: https://doi.org/10.3978/ j.issn.2078-6891.2012.030.
Lin B, Du L, Li H, Zhu X, Cui L, Li X. Tumor-infiltrating lymphocytes: warriors fight against tumors powerfully. Biomedicine & Pharmacotherapy (Biomedecine & Pharmacotherapie). 2020;132, 110873. Available from: https://doi.org/10.1016/j.biopha.2020.110873.
Huh JW, Lee JH, Kim HR. Prognostic significance of tumor-infiltrating lymphocytes for patients with colorectal cancer. Arch Surg (Chicago, Ill: 1960). 2012;147(4):366–72. Available from: https://doi.org/10.1001/archsurg.2012.35
Rozek LS, Schmit SL, Greenson JK, Tomsho LP, Rennert HS, Rennert G, et al. Tumor-infiltrating lymphocytes, Crohn's-like lymphoid reaction, and survival from colorectal cancer. Journal of the National Cancer Institute (JNCI). 2016;108(8):djw027. Available from: https://doi.org/10.1093/ jnci/djw027.
Golshani G, Zhang Y. Advances in immunotherapy for colorectal cancer: a review. Therap Adv Gastroenterol (TAG) 2020;13:1756284820917527. Available from: https://doi.org/10.1177/ 1756284820917527.
Ameer A, Akhtar F, Din HU, Ahmed R. Assessment of stromal and intra-epithelial tumor infiltrating lymphocytes in colorectal carcinoma at Armed Forces Institute of Pathology. Pak Armed Force Med. 2021;71 (2):392-5. Doi:10.51253/pafmj.v71i2.4764.
Granados-Romero J, Valderrama-Treviño AI, Contreras-Flores EH, Barrera-Mera B, Enríquez MH, Uriarte-Ruíz K, et al. Colorectal cancer: a review. I Int J Res Med Sci. 2017;5(11):4667-76. Doi: 10.18203/2320-6012.ijrms20174914.
Lotfollahzadeh S, Recio-Boiles A, Cagir B. Colon cancer. [Updated 2022 Dec 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih. gov/books/NBK470380/
American Cancer Society. Colorectal Cancer Facts & Figures 2011-2013. Atlanta: American Cancer Society, 2011.
Juárez-Vázquez C, Rosales-Reynoso M. Cancer colorrectal (CCR): alteraciones genéticas y moleculares. Gaceta Médica de México. 2014;150(2):154-6
Idos GE, Kwok J, Bonthala N, Kysh L, Gruber SB, Qu C. The prognostic implications of tumor infiltrating lymphocytes in colorectal cancer: a systematic review and meta-analysis. Sci Rep. 2020;10(1):3360. Doi: 10.1038/s41598-020-60255-4.
Huh JW, Lee JH, Kim HR. Prognostic significance of tumor-infiltrating lymphocytes for patients with colorectal cancer. Arch Surg. 2012;147(4):366–71.
Mei Z, Liu Y, Liu C, Cui A, Liang Z, Wang G, et al. Tumor-infiltrating inflammation and prognosis in colorectal cancer: systematic review and meta-analysis. Br J Cancer. 2014;1106:1595–605.
Varynen JP, Tuomisto A, Klintrup K, Makela J, Karttunen TJ, Makinen MJ. Detailed analysis of inflammatory cell infiltration in colorectal cancer. Br J Cancer. 2013;109(7):1839–47.
Teng F, Miu D, Meng X, Kong L, Zhu H, Liu S, et al. Tumor infiltrating lymphocytes (TILs) before and after neoadjuvant chemoradiotherapy and its clinical utility for rectal cancer. Am J Cancer Res. 2015;5(6):2064–74.
Nazemalhosseini-Mojarad E, Mohammadpour S, Torshizi EA, Gharib E, Larki P, Moradi A, et al. Intratumoral infiltrating lymphocytes correlate with improved survival in colorectal cancer patients: independent of oncogenetic features. J Cell Physiol. 2019;234(4):4768–77. Available from: https://doi.org/10.1002/jcp.27273.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Karina E. Clearesta, Toar Mambu, Ferdinand Tjandra, Fredrik G. Langi
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
COPYRIGHT
Authors who publish with this journal agree to the following terms:
Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.
Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.
Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).
