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Published on: September 13, 2018
Prognostic Significance of Tertiary Lymphoid Structure-Like Lymphocyte Aggregates in Routine Histopathological
Takeshi Sano1, Chisato Ohe1,2, Yusuke Motoki1
1Department of Urology and Andrology, Kansai Medical University, Hirakata-shi, Osaka, Japan.
Objective:
To evaluate the effect of tertiary lymphoid structure (TLS)-like lymphocyte aggregates in radical cystectomy (RC) specimens on the survival outcomes of patients with bladder cancer.
Methods:
We included 110 patients who underwent RC for urothelial carcinoma of the bladder. Hematoxylin and eosin-stained slides of RC specimens were evaluated for immune-related pathological results including the presence of TLS-like lymphocyte aggregates. Survival outcomes between groups were compared. The effects of various parameters on non-urinary tract recurrence-free survival (NUTRFS) were evaluated.
Results:
Among the 110 patients, TLS-like lymphocyte aggregates were identified in 65 (59.1%). Immunohistochemical evaluation of TLS-like lymphocyte aggregates in five selected patients using antibodies against CD4, CD8, and CD20 demonstrated that all lesions contained organized structures with T lymphocytes surrounding the B lymphocytes, consistent with TLSs. The median follow-up duration was 39.8 months (interquartile range, 14.7-79.3 months). Analyses of overall survival, cancer-specific survival, and NUTRFS showed that patients with TLS-like lymphocyte aggregates had significantly better outcomes than those without such aggregates. In both univariable and multivariable Cox proportional hazards analyses for NUTRFS, the presence of TLSs remained an independent and statistically significant prognostic factor, along with pathological T stage and lymph node status (hazard ratio 0.25, 95% confidence interval 0.12-0.52), indicating a favorable prognosis in patients with TLS-like lymphocyte aggregates.
Conclusions:
The findings of this study suggest that the presence of TLS-like lymphocyte aggregates observed on routinely used hematoxylin and eosin-stained slides of RC specimens may be an important predictor of survival outcomes after RC.
