Desmoplastic Reaction, Immune Cell Response, and Prognosis in Colorectal Cancer

Abstract

Background: The relationships between tumor stromal features (such as desmoplastic reaction, myxoid stroma, and keloid-like collagen bundles) and immune cells in the colorectal carcinoma microenvironment have not yet been fully characterized.

Methods: In 908 tumors with available tissue among 4,465 incident colorectal adenocarcinoma cases in two prospective cohort studies, we examined desmoplastic reaction, myxoid stroma, and keloid-like collagen bundles. We conducted multiplex immunofluorescence for T cells [CD3, CD4, CD8, CD45RO (PTPRC), and FOXP3] and for macrophages [CD68, CD86, IRF5, MAF, and MRC1 (CD206)]. We used the inverse probability weighting method and the 4,465 incident cancer cases to adjust for selection bias.

Results: Immature desmoplastic reaction was associated with lower densities of intraepithelial CD3⁺CD8⁺CD45RO⁺ cells [multivariable odds ratio (OR) for the highest (vs. lowest) density category, 0.43; 95% confidence interval (CI), 0.29-0.62; P_trend <0.0001] and stromal M1-like macrophages [the corresponding OR, 0.44; 95% CI, 0.28-0.70; P_trend = 0.0011]. Similar relations were observed for myxoid stroma [intraepithelial CD3⁺CD8⁺CD45RO⁺ cells (P_trend <0.0001) and stromal M1-like macrophages (P_trend = 0.0007)] and for keloid-like collagen bundles (P_trend <0.0001 for intraepithelial CD3⁺CD8⁺CD45RO⁺ cells). In colorectal cancer-specific survival analyses, multivariable-adjusted hazard ratios (with 95% confidence intervals) were 0.32 (0.23-0.44; P_trend <0.0001) for mature (vs. immature) desmoplastic reaction, 0.25 (0.16-0.39; P_trend <0.0001) for absent (vs. marked) myxoid stroma, and 0.12 (0.05-0.28; P_trend <0.0001) for absent (vs. marked) keloid-like collagen bundles.

Conclusions: Immature desmoplastic reaction and myxoid stroma were associated with lower densities of tumor intraepithelial memory cytotoxic T cells and stromal M1-like macrophages, likely reflecting interactions between tumor, immune, and stromal cells in the colorectal tumor microenvironment.

Keywords: cancer-associated fibroblast (CAF); clinical outcomes; host–tumor interaction; immune response; lymphocytic reaction; microsatellite instability; molecular pathological epidemiology (MPE); tumor immune microenvironment.