Strategies for clinical implementation of TNM-Immunoscore in resected nonsmall-cell lung cancer.
Donnem T., Kilvaer TK., Andersen S., Richardsen E., Paulsen EE., Hald SM., Al-Saad S., Brustugun OT., Helland A., Lund-Iversen M., Solberg S., Gronberg BH., Wahl SG., Helgeland L., Fløtten O., Pohl M., Al-Shibli K., Sandanger TM., Pezzella F., Busund LT., Bremnes RM.
Immunoscore is a prognostic tool defined to quantify in situ immune cell infiltrates and appears highly promising as a supplement to the tumor-node-metastasis (TNM) classification of various tumors. In colorectal cancer, an international task force has initiated prospective multicenter studies aiming to implement TNM-Immunoscore (TNM-I) in a routine clinical setting. In breast cancer, recommendations for the evaluation of tumor-infiltrating lymphocytes (TILs) have been proposed by an international working group. Regardless of promising results, there are potential obstacles related to implementing TNM-I into the clinic. Diverse methods may be needed for different malignancies and even within each cancer entity. Nevertheless, a uniform approach across malignancies would be advantageous. In nonsmall-cell lung cancer (NSCLC), there are several previous reports indicating an apparent prognostic importance of TILs, but studies on TILs in a TNM-I setting are sparse and no general recommendations are made. However, recently published data is promising, evoking a realistic hope of a clinical useful NSCLC TNM-I. This review will focus on the TNM-I potential in NSCLC and propose strategies for clinical implementation of a TNM-I in resected NSCLC.