胃癌组织内三级淋巴结构及其临床意义

Tertiary lymphoid structure in gastric cancer and its clinical significance

目的检测三级淋巴结构(tertiary lymphoid structure,TLS)在胃癌组织内的形成及其与临床病理特征和患者预后的关系。方法回顾性分析苏州大学附属第三医院2006～2008年存档的163例胃癌标本。经常规HE染色判读TLS组织学评分,分析其与胃癌临床病理特征和患者预后的关系。随机选取63例为验证组进行MECA-79免疫组化染色,分析其与TLS评分的一致性。结果 MECA-79与TLS评分具有相关性(P=0. 002)及一致性(P=0. 024)。TLS的形成与胃癌临床病理特征的关系差异无统计学意义。高密度TLS的胃癌患者中位生存期为48. 54个月,预后良好(P=0. 025)。多因素Cox回归模型中TLS是独立性预后因素(P=0. 031)。结论 TLS组织学评分准确可行。胃癌组织内TLS形成是提示患者预后良好的重要指标,反映肿瘤微环境(tumor microenvironment,TME)内抗肿瘤免疫功能良好,具有成为免疫治疗靶点的潜在可能。

Purpose To investigate the pathological features and prognostic value of tertiary lymphoid structure( TLS)formation in gastric cancer( GC). Methods HE staining slides were reviewed to evaluate the TLS in 163 specimens frompatients with GC in the Third Affiliated Hospital of Soochow University from 2006 to 2008. The validation cohort contained 63 randomly selected cases and immunohistochemical staining of MECA-79 was used to verify the accuracy of pathological assessment of TLS. Results TLS score and MECA-79 immunohistochemical staining showed significant correlation( P = 0. 002)and agreement( P = 0. 024). The TLS was not significantly correlated to clinical pathological parameters. The patients with highlevel of TLS had better prognosis( P = 0. 025) with the mean survival time of 48. 54 months. In multivariate Cox regression analysis,TLS was an independent prognostic factor( P = 0. 031).Conclusion The pathological evaluation of TLS is accurate.The formation of TLS is an important positive prognostic factor for GC patients.