Angiosarcomas are a rare subtype of soft-tissue sarcomas which exhibit aggressive clinical phenotypes with limited treatment options and poor outcomes.
In this study, we investigated the clinical relevance of the peripheral blood neutrophil-to-lymphocyte ratio (NLR) as a marker of systemic immune response, as well as its correlation with intra-tumoral immune profiles using the NanoString PanCancer IO360 panel and multiplex immunohistochemistry.
In the overall cohort (n=150), angiosarcomas of the head and neck comprised most cases (58.7%) and median overall survival (OS) was 1.1 year. NLR, classified as high in 78 of 112 (70%) evaluable patients, was independently correlated with worse OS (HR 1.84, 95%CI 1.18-2.87, p=0.0073), along with age >65 years and distant metastasis at diagnosis. Peripheral blood NLR was positively correlated with intra-tumoral NLR (tNLR) (Spearman’s rho 0.450, p=0.0067). Visualization of tumor-infiltrating immune cells confirmed that tNLR scores correlated directly with both neutrophil (CD15+ cells, rho 0.398, p=0.0198) and macrophage (CD68+ cells, rho 0.515, p=0.0018) cell counts. Interestingly, tNLR correlated positively with oncogenic pathway scores including angiogenesis, matrix remodelling & metastasis and cytokine & chemokine signaling, as well as myeloid compartment scores (all p<0.001). In patients with documented best clinical responses to first-line chemotherapy (n=60), these pathway scores were all significantly higher in non-responders (47%) compared to responders.
These findings suggest that systemic and local immune responses may inform clinical outcomes in angiosarcomas.
The authors.
SingHealth Duke-NUS Oncology ACP.
All authors have declared no conflicts of interest.