{"entity":{"id":"paper-pages-immunoscore-international-validation-lancet-2018","kind":"paper","name":"International validation of the consensus Immunoscore for the classification of colon cancer","aka":[],"tldr":"Counting two kinds of T cell in and around a bowel tumour, in a standardised way, across 14 centres in 13 countries, predicted recurrence better than the staging system and independently of it.","summary":"An international consortium of 14 centres in 13 countries assessed the consensus Immunoscore assay in patients with TNM stage I-III colon cancer, randomly assigned to training, internal validation and external validation sets. Paraffin sections of the tumour and invasive margin were processed by immunohistochemistry and the densities of CD3-positive and cytotoxic CD8-positive T cells quantified by digital pathology, with an Immunoscore derived from the mean of four density percentiles. Tissue from 3,539 patients was processed and 2,681 included after quality control. The assay was highly reproducible between observers and centres. In the training set, patients with a high Immunoscore had the lowest risk of recurrence at 5 years (8% against 19% intermediate and 32% low; hazard ratio 0.20 for high against low), and the findings were confirmed in both validation sets. In stratified multivariable analysis the association with time to recurrence was independent of age, sex, T stage, N stage, microsatellite instability and existing prognostic factors.","asOf":"2026-09-24","links":[{"label":"Pages et al., Lancet 2018: international validation of the consensus Immunoscore in 2,681 stage I-III colon cancers","url":"https://doi.org/10.1016/S0140-6736(18)30789-X"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/29754777/"}],"tags":[],"related":[],"cancers":["colorectal"],"sections":[],"technologies":["histopathology-ihc","ihc-autostainers-histology-automation"],"targets":[],"drugs":[],"companies":[],"institutions":["institut-curie"],"pathways":["tumor-microenvironment","cancer-immunity-cycle"],"terms":["ihc","msi"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":[],"journals":["lancet"],"dependsOn":[],"notes":[],"journal":"Lancet","year":2018,"doi":"10.1016/S0140-6736(18)30789-X","pmid":"29754777","authors":"Pages F, Mlecnik B, Marliot F, et al.","paperType":"observational","findings":["High Immunoscore carried a hazard ratio of 0.20 for time to recurrence against low.","Prognostic independently of T stage, N stage and microsatellite instability.","Highly reproducible between observers and centres."],"whatItMeans":"It is the strongest evidence that an immune measurement should sit beside TNM staging in colon cancer, and the basis for using it to decide adjuvant chemotherapy in stage II disease, which is where the argument is now.","caveats":["Prognostic, not predictive of benefit from any particular treatment.","Requires standardised digital pathology and a commercial assay.","No guideline mandates it and no approval depends on it."],"changedPractice":false,"participants":2681},"route":"/key-papers/paper-pages-immunoscore-international-validation-lancet-2018/","neighbours":{"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"}],"technology":[{"id":"ihc-autostainers-histology-automation","kind":"technology","name":"Histology automation and IHC autostainers","route":"/technologies/ihc-autostainers-histology-automation/"},{"id":"histopathology-ihc","kind":"technology","name":"Histopathology & immunohistochemistry","route":"/technologies/histopathology-ihc/"}],"institution":[{"id":"institut-curie","kind":"institution","name":"Institut Curie","route":"/institutions/institut-curie/"}],"pathway":[{"id":"cancer-immunity-cycle","kind":"pathway","name":"The cancer-immunity cycle","route":"/pathways/cancer-immunity-cycle/"},{"id":"tumor-microenvironment","kind":"pathway","name":"Tumour microenvironment (TME)","route":"/pathways/tumor-microenvironment/"}],"term":[{"id":"ihc","kind":"term","name":"Immunohistochemistry (IHC)","route":"/terms/ihc/"},{"id":"msi","kind":"term","name":"Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR)","route":"/terms/msi/"}],"journal":[{"id":"lancet","kind":"journal","name":"The Lancet","route":"/journals/lancet/"}]}}