The tumor immune microenvironment in octogenarians with stage I non-small cell lung cancer.
Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related mortality and has increasingly become a disease of elderly patients. Elderly patients are underrepresented in clinical trials that evaluate treatments for NSCLC. It has been suggested that patients >65 years of age have less robust immune responses to infections, immunizations, and tumors compared with younger patients. With increasing focus and number of immunotherapy clinical trials for NSCLC, we investigated the relationship between patient age and the tumor immune microenvironment in NSCLC. Using tissue microarrays from 1,278 patients with surgically resected Stage I NSCLC (≤65 years [33%], 66-79 years [55%], and ≥80 years [12%]), we determined whether quantitative and qualitative immune cell infiltration in the tumor differed between younger and older patients. Furthermore, we investigated the prognostic value of immune cell infiltration with respect to recurrence in octogenarians. We found that there were no statistically significant differences between older and younger patients in tumoral immune infiltration or effector regulatory immune response ratios (FoxP3/CD3, FoxP3/CD4, and FoxP3/CD8 ratios). In octogenarians, presence of low tumoral CD68+immune cells was an independent predictor of recurrence. In the uniform cohort of surgically selected and resected Stage I NSCLC patients, tumor immune cell infiltration among the older age group resembled other age groups. Our study provides information that supports inclusion of older age patients selected for surgical resection in neoadjuvant or adjuvant immunotherapy clinical trials for lung cancer.
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY ; Institute of Clinical Medicine; National Yang-Ming University ; Taipei, Taiwan.
Ming-Ching
MC
Lee
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY.
Daniel H
DH
Buitrago
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY ; Department of Pathology; Memorial Sloan Kettering Cancer Center ; New York, NY.
Kyuichi
K
Kadota
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY.
Hideki
H
Ujiie
Department of Epidemiology & Biostatistics; Memorial Sloan Kettering Cancer Center ; New York, NY.
Kaitlin
K
Woo
Department of Epidemiology & Biostatistics; Memorial Sloan Kettering Cancer Center ; New York, NY.
Camelia S
CS
Sima
Department of Pathology; Memorial Sloan Kettering Cancer Center ; New York, NY.
William D
WD
Travis
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY.
David R
DR
Jones
Thoracic Service; Department of Surgery; Memorial Sloan Kettering Cancer Center ; New York, NY ; Center for Cell Engineering; Memorial Sloan Kettering Cancer Center ; New York, NY.
Prasad S
PS
Adusumilli
ADC, adenocarcinoma; CIR, cumulative incidence of recurrence; CT, computed tomography; FoxP3, forkhead box P3; H&E, hematoxylin and eosin; NSCLC, non-small cell lung cancer; SCC, squamous cell carcinoma; TMA, tissue microarray; TiL, tumor-infiltrating lymphocyte; forkhead box P3; non-small cell lung cancer; octogenarians; old age; tumor-infiltrating lymphocytes