IMMUNE AND INFLAMATORYRESPONSE HETEROGENEITY IN NEUROBLASTOMA Nöroblastomda immun ve inflamatuar cevapta heterojenite

Objectives: Immunity and inflammatory response are the mostimportant features in cancer development, progression, andsurvival. Prognostic significance of immune and inflammationrelated markers in neuroblastoma before and after treatment andduring the follow-up period has not been adequately investigated.The aim of this study is to investigate the prognostic importanceof immune and inflammation-related markers in neuroblastoma.Materials-Methods: In 1750 neuroblastoma cases examinedbetween 2012-2022, achievable blood albumin, CRP values andratio (Glascow Prognostic score), diversity and amount ofimmune cell infiltration in tumor tissue and surrounding tissue,immunohistochemical CTLA-4, PDL-1, PD-1, PDL-2expression was evaluated. RESULTS were tested with analysisof variance and survival at p<0.05 significance.Results: The mean age of the cases was 36.23±39.90 (1-217months) and 48.6% were girls and 51.4% were boys. 28% of thecases are in low risk, 23.3% in medium risk, 48.7% in high-riskclass. Lymphocyte infiltration was detected in 6% and a lownumber in neuroblastoma cases before treatment. Noheterogeneity was detected in the expression of CTLA-4, PDL1,PD1. After multimodal chemotherapy, lymphocyte infiltrationwas found significantly more in tissues with differentiatedganglioneuroma. It was noted that immunity did not showintertumoral heterogeneity.Conclusions: Neuroblastoma was found to be weak in immuneand inflammatory response. Absence of intratumoralheterogeneity in immune response, increased immune cellincrease after chemotherapy were interpreted in favor ofmetachronous immune heterogeneity. In vitro, ex vivo and invivo studies are needed to determine the immune profile changesin tumors after radiotherapy and chemotherapy, in short, whetherneuroblastomas can be converted from cold tumors to hot tumorsfor immunotherapy.Keywords: Neuroblastoma, heterogeneity, immune response,inflamatory response