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Cancer classification using the Immunoscore: a worldwide task force

Jérôme Galon12345*, Franck Pagès1234, Francesco M Marincola56, Helen K Angell123, Magdalena Thurin7, Alessandro Lugli8, Inti Zlobec8, Anne Berger4, Carlo Bifulco9, Gerardo Botti10, Fabiana Tatangelo10, Cedrik M Britten11, Sebastian Kreiter11, Lotfi Chouchane12, Paolo Delrio13, Hartmann Arndt14, Martin Asslaber15, Michele Maio16, Giuseppe V Masucci17, Martin Mihm18, Fernando Vidal-Vanaclocha19, James P Allison20, Sacha Gnjatic20, Leif Hakansson21, Christoph Huber11, Harpreet Singh-Jasuja22, Christian Ottensmeier23, Heinz Zwierzina24, Luigi Laghi25, Fabio Grizzi25, Pamela S Ohashi26, Patricia A Shaw27, Blaise A Clarke27, Bradly G Wouters27, Yutaka Kawakami28, Shoichi Hazama29, Kiyotaka Okuno30, Ena Wang6, Jill O'Donnell-Tormey31, Christine Lagorce32, Graham Pawelec33, Michael I Nishimura34, Robert Hawkins35, Réjean Lapointe36, Andreas Lundqvist37, Samir N Khleif38, Shuji Ogino39, Peter Gibbs40, Paul Waring41, Noriyuki Sato42, Toshihiko Torigoe42, Kyogo Itoh43, Prabhu S Patel44, Shilin N Shukla44, Richard Palmqvist45, Iris D Nagtegaal46, Yili Wang47, Corrado D'Arrigo48, Scott Kopetz49, Frank A Sinicrope50, Giorgio Trinchieri51, Thomas F Gajewski552, Paolo A Ascierto5354 and Bernard A Fox55556

Author Affiliations

1 INSERM, U872, Laboratory of Integrative Cancer Immunology, Paris, F-75006, France

2 Université Paris Descartes, Paris, France

3 Centre de Recherche des Cordeliers, Université Pierre et Marie Curie Paris 6, Paris, France

4 Assistance Publique-Hopitaux de Paris, HEGP, Paris, France

5 Society for Immunotherapy of Cancer, Milwaukee, WI, USA

6 Infectious Disease and Immunogenetics Section (IDIS), Clinical Center and trans-NIH Center for Human Immunology (CHI), National Institutes of Health, Bethesda, Maryland, USA

7 Cancer Diagnosis Program, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA

8 Institute of Pathology, University of Bern, Bern, 3010, Switzerland

9 Department of Pathology, Providence Portland Medical Center, Portland, OR, USA

10 Department of Pathology, Istituto Nazionale per lo Studio e la Cura dei Tumori "Fondazione G.Pascale", Naples, Italy

11 TRON - Translational Oncology at the University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany

12 Weill Cornell Medical College, Doha, Qatar

13 Colorectal Surgery Department, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G.Pascale", Naples, Italy

14 Department of Pathology, University of Erlangen, Erlangen, Germany

15 Institute of Pathology, Medical University of Graz, Graz, Austria

16 Division of Medical Oncology and Immunotherapy, University Hospital of Siena, Istituto Toscano Tumori, Siena, Italy

17 Department of Oncology-Pathology, Karolinska Institutet, Karolinska University, Stockholm, Sweden

18 Harvard Medical School and Massachusetts General Hospital, Boston, MA, 02114-2696, USA

19 CEU-San Pablo University School of Medicine and HM-Hospital of Madrid Scientific Foundation, Institute of Applied Molecular Medicine (IMMA), Madrid, Spain

20 Ludwig Institute for Cancer Research, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

21 University of Lund, Lund, Sweden

22 Immatics Biotechnologies GmbH, Tübingen, Germany

23 Experimental Cancer Medicine Centre, University of Southampton Faculty of Medicine, Southampton, United Kingdom

24 Department Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria

25 Molecular Gastroenterology and Department of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy

26 Ontario Cancer Institute and Campbell Family Institute for Cancer Research, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada

27 Departments of Laboratory Medicine, Pathobiology & Radiation Oncology, Ontario Cancer Institute/Princess Margaret Cancer Centre, Toronto, ON, Canada

28 Division of Cellular Signaling, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan

29 Department of Digestive Surgery and Surgical Oncology, Yamaguchi University, Graduate School of Medicine, Yamaguchi, Japan

30 Department of Surgery, Kinki University, School of Medicine, Osaka-sayama, Japan

31 Cancer Research Institute, New York, NY, USA

32 Department of Pathology, Avicenne Hospital, AP-HP, Bobigny, France

33 Center for Medical Research, University of Tuebingen, Tuebingen, Germany

34 Oncology Institute, Loyola University Medical Center, Cardinal Bernardin Cancer Center, Maywood, IL, USA

35 School of Cancer and Imaging Sciences, University of Manchester, Christie Hospital NHS Trust, Manchester, UK

36 Research Center, University Hospital, Université de Montréal (CRCHUM), Montréal, Québec, Canada ; Institut du Cancer de Montréal, Montréal, Québec, Canada

37 Karolinska Institutet Department of Oncology-Pathology, Stockholm, Sweden

38 Georgia Health Sciences University Cancer Center, Augusta, GA, USA

39 Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA

40 Department of Medical Oncology, Royal Melbourne Hospital, Melbourne, Australia

41 Department of Pathology, The University of Melbourne, Melbourne, Australia

42 Department of Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan

43 Department of Immunology and Immunotherapy, Kurume University School of Medicine, Kurume, Japan

44 The Gujarat Cancer & Research Institute, Asarwa, Ahmedabad, India

45 Department of Medical Biosciences, Pathology, Umea University, Umea, Sweden

46 Pathology Department, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

47 Institute for Cancer Research, Center of Translational medicine, Xi’an Jiaotong university, Xian, China

48 Department of Histopathology, Dorset County Hospital, DCHFT, NHS, Dorchester, UK

49 MD Anderson Cancer Center, Houston, TX, USA

50 Mayo Clinic and Mayo College of Medicine, Rochester, MN, 55905, USA

51 Cancer Inflammation Program, Center for Cancer Research, National Cancer Institute and Trans-NIH Center for Human Immunology (CHI), National Institutes of Health, Frederick and Bethesda, Maryland, USA

52 University of Chicago, Chicago, IL, USA

53 Medical Oncology and Innovative Therapies Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, "Fondazione G. Pascale", Napoli, Italy

54 Fondazione Melanoma Onlus, Napoli, Italy

55 Laboratory of Molecular and Tumor Immunology, Earle A. Chiles Research Institute, Robert W. Franz Cancer Center, Providence Portland Medical Center, Portland, OR, USA

56 Department of Molecular Microbiology and Immunology, Oregon Health and Science University, Portland, OR, USA

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Journal of Translational Medicine 2012, 10:205  doi:10.1186/1479-5876-10-205

Published: 3 October 2012


Prediction of clinical outcome in cancer is usually achieved by histopathological evaluation of tissue samples obtained during surgical resection of the primary tumor. Traditional tumor staging (AJCC/UICC-TNM classification) summarizes data on tumor burden (T), presence of cancer cells in draining and regional lymph nodes (N) and evidence for metastases (M). However, it is now recognized that clinical outcome can significantly vary among patients within the same stage. The current classification provides limited prognostic information, and does not predict response to therapy. Recent literature has alluded to the importance of the host immune system in controlling tumor progression. Thus, evidence supports the notion to include immunological biomarkers, implemented as a tool for the prediction of prognosis and response to therapy. Accumulating data, collected from large cohorts of human cancers, has demonstrated the impact of immune-classification, which has a prognostic value that may add to the significance of the AJCC/UICC TNM-classification. It is therefore imperative to begin to incorporate the ‘Immunoscore’ into traditional classification, thus providing an essential prognostic and potentially predictive tool. Introduction of this parameter as a biomarker to classify cancers, as part of routine diagnostic and prognostic assessment of tumors, will facilitate clinical decision-making including rational stratification of patient treatment. Equally, the inherent complexity of quantitative immunohistochemistry, in conjunction with protocol variation across laboratories, analysis of different immune cell types, inconsistent region selection criteria, and variable ways to quantify immune infiltration, all underline the urgent requirement to reach assay harmonization. In an effort to promote the Immunoscore in routine clinical settings, an international task force was initiated. This review represents a follow-up of the announcement of this initiative, and of the J Transl Med. editorial from January 2012. Immunophenotyping of tumors may provide crucial novel prognostic information. The results of this international validation may result in the implementation of the Immunoscore as a new component for the classification of cancer, designated TNM-I (TNM-Immune).