**7. Conclusions**

CRC is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death in the world. There are five CMS of CRC: the MSI-immune, the canonical subtype, the metabolic subtype, and the last subtype with mixed features. The strength of the in situ adaptive immune reaction is strongly correlated with time to recurrence and overall survival of CRC which leads us to think that the immune system plays an important role in CRC development. The consensus Immunoscore is a scoring system that outlines the density of CD3+ and CD8+ T-cell effectors existent in the tumor and its invasive margin, and the authors believe that this score could be a good prognostic marker. On the other hand, the dysbiosis could be combined with Immunoscore to increase the power of the biomarker. Studies about this interaction are needed. The role of microbiota in colorectal cancer is complex: its disturbance is the cause of tumorigenesis, or the outcome of tumor development is still uncertain.

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**Author details**

Filipa Macedo1

Portugal

Sao Paulo, Brazil

and Sandra F. Martins2,3,6\*

, Nuno Bonito1

University of Minho, Braga, Portugal

provided the original work is properly cited.

1 Portuguese Oncology Institute, Coimbra, Portugal

, Adhemar Longatto-Filho2,3,4,5

2 Life and Health Science Research Institute (ICVS), School of Medicine,

4 Molecular Oncology Research Center, Barretos, São Paulo, Brazil

\*Address all correspondence to: sandramartins@med.uminho.pt

3 ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Braga,

6 Surgery Department, Coloproctology Unit, Braga Hospital, Braga, Portugal

5 Laboratory of Medical Investigation (LIM) 14, Faculty of Medicine, University of

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

*Immunoscore and Microbiome in Colorectal Cancer: What's New?*

*DOI: http://dx.doi.org/10.5772/intechopen.86605*
