Tumor-Infiltrating Lymphocytes and Colorectal Cancer Survival in African American and Caucasian Patients

Background: Compared with Caucasian Americans (CAs), African Americans (AAs) with colorectal cancer have poorer survival, especially younger-age patients. A robust lymphocytic reaction within colorectal cancers is strongly associated with better survival, but whether immune response impacts the disparity in colorectal cancer survival is unknown. Methods: The study population was comprised of 211 histologically confirmed colorectal cancers at the Medical University of South Carolina (Charleston, SC; 159 CAs and 52 AAs) diagnosed between Jan 01, 2000, and lune 30, 2013. We constructed a lymphocyte score based on blinded pathologic assessment of the four different types of lymphorytic reactions. Cox proportional hazards regression was used to evaluate the association between the lymphocyte score and. risk of death by race. Results: Colorectal cancers in AAs (vs (As) had a stronger lymphocytic reaction at diagnosis. A high lymphocyte score (vs. the lowest) was associated with better survival in AAs II IR 0, I 9; 95% confidence interval (CI), 0.04-0.991 and CM (HR 0.47; 95% Cl, 0.15-1.45). AAs with no lymphocytic reaction (vs. other categories) had poor survival HR 4.48 (1.58-12.7) whereas no difference was observed in CAs. The risk of death in AM (vs. CA) was more pronounced in younger patients (HR 2.92; 95% CI, 1.18-7.22) compared with older (HR 1.20; 95% CI, 0.54-2.67 especially those with lymphocytic poor colorectal cancers. Conclusions: The lymphocytic reaction in tumor impacted the racial disparity in survival. Impact: Our results confirm the importance of the lymphocytic score on survival and highlight the. need to fully characterize the immune environment of colorectal cancers by race. (C)2018 AACR.