INTRODUCTION The host anti-tumour inflammatory response is a strong prognostic indicator, and tumour infiltrating lymphocytes (TILs) are believed to have a complimentary role alongside TNM assessment in dictating future management. However, there is wide disagreement regarding the most efficacious and cost-effective method of assessment. METHODS A comprehensive literature search was performed of EMBASE, MedLine and PubMed as well as an assessment of references to identify all relevant studies relating to the assessment of the peri-tumoural inflammatory response or TILs and prognosis in colorectal cancer (CRC). A meta-analysis was performed of 67 studies meeting the REMARK criteria using RevMan software. RESULTS Intratumoural assessment of both CD3 and CD8 in CRC were significant for disease-free survival (DFS) (combined HRs 0.46; 95%CI: 0.39-0.54 and 0.54; 95%CI: 0.45-0.65), as well as overall survival (OS) and disease-specific survival (DSS). The same was true for assessment of CD3 and CD8 at the invasive margin (DFS: combined HRs 0.45; 95%CI: 0.33-0.61 and 0.51; 95%CI: 0.41-0.62). However, similar fixed effects summaries were also observed for H&E-based methods, like Klintrup-Makinen grade (DFS: HR 0.62; 95%CI: 0.43-0.88). Furthermore, inflammatory assessments were independent of MSI status. CONCLUSION The evidence suggests that it is the density of a co-ordinated local inflammatory infiltrate that confers survival benefit, rather than any individual immune cell subtype. Furthermore, the location of individual cells within the tumour microenvironment does not appear to influence survival. The authors advocate a standardised assessment of the local inflammatory response, but caution against emphasizing the importance of any individual immune cell subtype.

中文翻译：

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大肠癌的局部炎症反应-类型，位置或密度？系统的审查和荟萃分析。

引言宿主抗肿瘤炎症反应是一个强有力的预后指标，肿瘤浸润淋巴细胞（TILs）与TNM评估在决定未来治疗方面具有互补作用。但是，关于最有效和最具成本效益的评估方法存在广泛的分歧。方法对EMBASE，MedLine和PubMed进行了全面的文献检索，并对参考文献进行了评估，以鉴定与评估肿瘤周围炎症反应或TIL和结直肠癌（CRC）的预后有关的所有相关研究。使用RevMan软件对符合REMARK标准的67项研究进行了荟萃分析。结果CRC中CD3和CD8的肿瘤内评估对无病生存期（DFS）均具有重要意义（合并HR值为0.46； 95％CI：0.39-0。54和0.54；95％CI：0.45-0.65），以及总生存期（OS）和疾病特异性生存期（DSS）。对于在有创边缘的CD3和CD8评估也是如此（DFS：合并HR 0.45； 95％CI：0.33-0.61和0.51； 95％CI：0.41-0.62）。但是，对于基于H＆E的方法，例如Klintrup-Makinen等级（DFS：HR 0.62； 95％CI：0.43-0.88），也观察到了类似的固定效果摘要。此外，炎症评估与MSI状态无关。结论证据表明，赋予生存益处的是协调的局部炎症浸润的密度，而不是任何单个免疫细胞亚型。此外，肿瘤微环境中单个细胞的位置似乎不影响生存。作者主张对局部炎症反应进行标准化评估，