Immunoscore: redefining the landscape of colorectal cancer control and care

The Immunoscore (IS), introduced by Jerome Galon in the early 2000s, evaluates immune cell densities within tumors, offering a more accurate prediction of clinical outcomes in colorectal cancer (CRC) compared to the TNM system. Studies have demonstrated that IS enhances the prediction of recurrence, disease-free survival, and overall survival in early-stage CRC, identifying high-risk patients and optimizing treatment decisions. The IS serves as a prognostic tool with high predictive value in guiding immunotherapy, especially immune checkpoint inhibitors (ICIs). Studies show that high IS scores correlate with better response rates to ICI therapy, facilitating personalized treatment. In addition to CRC, the IS has demonstrated utility across various cancers by predicting treatment responses and survival outcomes. Despite its advantages, the IS faces limitations with traditional tumor-infiltrating lymphocyte assessments. Moreover, the IS's application in guiding adjuvant chemotherapy is constrained by cost and limited data. Nonetheless, advancements combining IS with markers like p21 and p16(INK4a) as well as integrating artificial intelligence and digital pathology, enhance prognostic predictions and patient management. Overall, the IS represents a significant advancement in oncology, with ongoing research likely to further enhance its utility across diverse cancer types.