Immune system and prognosis in colorectal cancer: a detailed immunohistochemical analysis

The efficacy of tumor cell-immune cell interactions depends on a number of factors, for example, the expression of HLA-I on tumor cells, the type of immune cell, the accessibility of tumor cells for immune cells and the expression of immunogenic epitopes. We assessed infiltration of CD4+, CD8+, CD56+ and CD57+ cells in the tumor epithelium, tumor stroma and advancing tumor margin of 93 colorectal carcinomas and correlated this to clinicopathological parameters, the expression of HLA-A and HLA-B/C on tumor cells, the presence of a basal membrane (BM)-like structure surrounding tumor nodules and the presence of microsatellite instability/mutator phenotype (absent MLH-1 expression). The median intraepithelial CD4+, CD8+, CD56+ and CD57+ cell infiltrations were 3, 23, 0 and 0 cells/mm(2) tumor, respectively. HLA-A/BC expression by tumor cells was normal in 28/43%, heterogeneous in 59/48% and absent in 13/9% of the cases. A BM-like structure surrounding the tumor nodules was absent, present and thick in 47, 38 and 15% of the cases. Six cases lost MLH1 expression. There was a positive correlation between leukocyte infiltration in the three compartments for CD4+, CD8+, CD56+ (partly) and CD57+ (all P<0.05) cell infiltration. Intraepithelial CD8+ cell infiltration inversely correlated with HLA-A (P=0.04) and HLA-B/C expression (P=0.04). Intraepithelial CD57+ cell infiltration inversely correlated with HLA-B/C expression (P=0.04). Moreover, intraepithelial infiltration of CD8+ and CD57+ cells was inversely correlated to the presence of a BM-like structure (P=0.003 and 0.04, respectively). Uni- and multivariate analyses showed that a lower tumor stage (P=0.004) and marked infiltration of CD8+ (P=0.04) and CD57+ cells (P=0.05) at the advancing tumor margin were independent prognostic factors for a longer disease-free survival. Loss of MLH1 expression was correlated with a significantly higher intraepithelial CD8+ and CD57+ cell infiltration. We conclude that infiltration of CD8+ and CD57+ cells are important prognostic factors in colorectal cancer. However, their interaction with tumor cells is inversely correlated to the presence of HLA-I on tumor cells and a thick BM-like structure around tumor islets. Our data indicate that NK cells might play an important role in the immune surveillance in colorectal cancer patients.