Towards the introduction of the 'Immunoscore' in the classification of malignant tumours

Jérôme Galon, Bernhard Mlecnik, Gabriela Bindea, Helen K. Angell, Anne Berger, Christine Lagorce, Alessandro Lugli, Inti Zlobec, Arndt Hartmann, Carlo Bifulco, Iris D. Nagtegaal, Richard Palmqvist, Giuseppe V. Masucci, Gerardo Botti, Fabiana Tatangelo, Paolo Delrio, Michele Maio, Luigi Laghi, Fabio Grizzi, Martin AsslaberCorrado D'Arrigo, Fernando Vidal-Vanaclocha, Eva Zavadova, Lotfi Chouchane, Pamela S. Ohashi, Sara Hafezi-Bakhtiari, Bradly G. Wouters, Michael Roehrl, Linh Nguyen, Yutaka Kawakami, Shoichi Hazama, Kiyotaka Okuno, Shuji Ogino, Peter Gibbs, Paul Waring, Noriyuki Sato, Toshihiko Torigoe, Kyogo Itoh, Prabhu S. Patel, Shilin N. Shukla, Yili Wang, Scott Kopetz, Frank A. Sinicrope, Viorel Scripcariu, Paolo A. Ascierto, Francesco M. Marincola, Bernard A. Fox, Franck Pagès

Research output: Contribution to journalReview articlepeer-review

1073 Citations (Scopus)


The American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) TNM staging system provides the most reliable guidelines for the routine prognostication and treatment of colorectal carcinoma. This traditional tumour staging summarizes data on tumour burden (T), the presence of cancer cells in draining and regional lymph nodes (N) and evidence for distant metastases (M). However, it is now recognized that the clinical outcome can vary significantly among patients within the same stage. The current classification provides limited prognostic information and does not predict response to therapy. Multiple ways to classify cancer and to distinguish different subtypes of colorectal cancer have been proposed, including morphology, cell origin, molecular pathways, mutation status and gene expression-based stratification. These parameters rely on tumour-cell characteristics. Extensive literature has investigated the host immune response against cancer and demonstrated the prognostic impact of the in situ immune cell infiltrate in tumours. A methodology named 'Immunoscore' has been defined to quantify the in situ immune infiltrate. In colorectal cancer, the Immunoscore may add to the significance of the current AJCC/UICC TNM classification, since it has been demonstrated to be a prognostic factor superior to the AJCC/UICC TNM classification. An international consortium has been initiated to validate and promote the Immunoscore in routine clinical settings. The results of this international consortium may result in the implementation of the Immunoscore as a new component for the classification of cancer, designated TNM-I (TNM-Immune).

Original languageEnglish
Pages (from-to)199-209
Number of pages11
JournalJournal of Pathology
Issue number2
Publication statusPublished - 2014 Jan
Externally publishedYes


  • Immunoscore
  • T cells
  • classification
  • colon carcinoma
  • colorectal cancer
  • immune response
  • predictive markers
  • prognostic markers
  • tumour microenvironment

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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