免疫微环境和dMMR胃癌的治疗反应:异质性和对免疫疗法的影响
Liping Wang1, Xinliang Zhong1, Mengxing Diao1
1Department of Medical Oncology, Southern University of Science and Technology Hospital, Shenzhen, Guangdong 518055, P.R. China.
Oncology letters
|February 9, 2026
概括
缺陷不匹配修复 (dMMR) 的高瘤突变负担 (TMB) 的胃癌显示出不同的免疫疗法反应. 低CD8+ T细胞和高Tregs表明耐药性,这表明个性化瘤免疫微环境 (TIME) 评估对于预测结果至关重要.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 基因组学就是基因组学.
背景情况:
- 缺陷不匹配修复 (dMMR) 的胃癌表现出高瘤突变负担 (TMB) 和新抗原负载,可能提高免疫治疗的敏感性.
- 然而,异质的患者反应突出了复杂的瘤免疫微环境 (TIME) 调节.
研究的目的:
- 将dMMR胃癌病例与多队列生物信息分析相结合,以确定免疫治疗结果的TIME决定因素.
- 专注于血液免疫细胞子集和免疫治疗前后的时间变化.
主要方法:
- 在dMMR胃癌患者中,免疫细胞子集 (CD8+,CD4+,FoxP3+Tregs,M1/M2巨,PD-L1) 的免疫组织化学分析.
- 在TCGA-STAD,Kim,PKUH和EGC-MSK-2017队列中,生物信息学分析了MSI状态,免疫检查点 (CTLA4,CD274,PDCD1),TMB和TIME细胞透,使用CIBERSORT和R.
主要成果:
- 在dMMR病例中显示了治疗前的"免疫感冒" (低CD8+T细胞,M1巨细胞,Tregs) 和治疗后增加的CD4+T细胞,持续低CD8+T细胞.
- 高MSI (MSI-H) 的胃癌与低MSI/微卫星稳定性 (MSS) 的瘤相比,显示出有利的免疫特征 (更高的TMB,新抗原负载,记忆CD4+T细胞,NK细胞,M1巨细胞,免疫检查点).
- 在特定的队列中,MSI-H与更高的TMB和免疫疗法响应率有关,趋势是改善整体存活率 (OS),尽管在统计学上并不显著.
结论:
- 在dMMR/MSI-H瘤中,具有低CD8+T细胞,高Tregs,缺少TLS和低PD-L1的TIME可以预测免疫疗法耐药性.
- 尽管免疫学标记有利,但MSI-H胃癌显示出异质的免疫治疗结果.
- 单独的dMMR/MSI-H状态不足以预测结果;对于接受免疫治疗的胃癌患者,个性化的TIME评估是必不可少的.
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