Immunological and prognostic significance of tumour necrosis in colorectal cancer

• Published in: British journal of cancer Vol. 128; no. 12; pp. 2218 - 2226
• Main Authors: Kastinen, Meeri, Sirniö, Päivi, Elomaa, Hanna, Ahtiainen, Maarit, Väyrynen, Sara A., Herzig, Karl-Heinz, Meriläinen, Sanna, Aro, Raila, Häivälä, Reetta, Rautio, Tero, Saarnio, Juha, Wirta, Erkki-Ville, Helminen, Olli, Seppälä, Toni T., Kuopio, Teijo, Böhm, Jan, Tuomisto, Anne, Mecklin, Jukka-Pekka, Mäkinen, Markus J., Väyrynen, Juha P.
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 29-06-2023; Nature Publishing Group
• Subjects: 631/67/1504/1885; 631/67/1857; 631/67/327; Biomedical and Life Sciences; Biomedicine; Cancer; Cancer Research; Chemokines; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms - pathology; CXCL10 protein; Cytokines; Drug Resistance; Epidemiology; Humans; Immunology; Inflammation; Medical prognosis; Mismatch repair; Molecular Medicine; Necrosis; Oncology; Prognosis; Serum levels; Tumors
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/s41416-023-02258-2

Background
Colorectal cancer (CRC) causes the second most cancer deaths worldwide, but the disease course varies according to tumour characteristics and immunological factors. Our objective was to examine the associations of tumour necrosis with tumour characteristics, immune cell infiltrates, serum cytokine concentrations, as well as prognosis in CRC.
Methods
Three independent CRC cohorts, including 1413 patients, were analysed. Associations of the areal percentage of tumour necrosis with clinicopathologic parameters, tumour infiltrating immune cells, cytokine concentrations in systemic and mesenteric vein blood, and survival were examined.
Results
Higher tumour necrosis percentage associated with shorter colorectal cancer-specific survival independent of tumour grade, T, N or M-class, mismatch repair status,
BRAF
status, and other possible confounding factors. In the largest cohort (
N
 = 1100), the HR for high tumour necrosis percentage (≥40% vs. <3%) was 3.22 (95% CI 1.68–6.17,
P
trend
 < 0.0001). Tumour necrosis percentage positively correlated with peripheral serum levels of CXCL8, a proinflammatory chemokine, and negatively correlated with mesenteric serum levels of CXCL10 and mast cell densities in the invasive margin of the tumour.
Conclusions
Our results support the value of tumour necrosis as a prognostic factor in colorectal cancer. CXCL8 may have a role in the systemic effects of tumour necrosis.