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Invited Critique
Apr 2012

Survival Prediction for Patients With Colorectal Carcinoma Incorporating Tumor-Infiltrating Lymphocyte GradeComment on “Prognostic Significance of Tumor-Infiltrating Lymphocytes for Patients With Colorectal Cancer”

Arch Surg. 2012;147(4):371-372. doi:10.1001/archsurg.2012.160

Huh et al1 of the Departments of Surgery and Pathology, Chonnam National University Hwasun Hospital and Medical School, Gwangju, Korea, evaluated a population of 546 patients who were retrospectively analyzed after undergoing curative surgery for primary nonmetastatic colorectal cancer (2004-2007). The authors determined the prognostic value of macroscopic ulceration tumor border configuration and tumor-infiltrating lymphocytes (TILs) determined at the invasive margin. Thereafter, the authors differentiated the individual tumor characteristics of high vs low TIL grade and correlated these with commonly identified pathologic tumor characteristics (poorly differentiated vs perineural invasive status). Of interest, with a median 54-month follow-up interval, overall survival and disease-free survival rates were statistically significantly lower for the low TIL group vs the high TIL group of patients with stage III colorectal carcinoma (P = .005 and P = .03, respectively). The effect on overall and disease-free survival was not evident in patients with stage I and II cancers when correlated with the low vs high TIL groups. Moreover, the authors determined that a similar correlation was evident with TIL grade for prognostic significance on distant metastasis–free survival and liver metastasis–free survival in patients with rectal carcinoma (P = .81). Although this trend in association of worst prognosis with low TIL grade is evident in colorectal multivariant analysis, its overall value for outcomes risk among these 281 studied patients with rectal cancer did not correlate with local recurrence–free survival in this 5-year study cohort.

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