Int J Med Sci 2021; 18(11):2327-2338. doi:10.7150/ijms.56347 This issue

Research Paper

Relationship between Tertiary Lymphoid Structure and the Prognosis and Clinicopathologic Characteristics in Solid Tumors

Zhan Zhao1*, Hui Ding1*, Zheng-bin Lin1, Sheng-hui Qiu1, Yi-ran Zhang1, Yan-guan Guo1, Xiao-dong Chu1, Loi I Sam2, Jing-hua Pan1✉, Yun-long Pan1✉

1. Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou 510632, China.
2. International School, Jinan University, Guangzhou 510632, China.
* These authors contributed equally.

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Citation:
Zhao Z, Ding H, Lin Zb, Qiu Sh, Zhang Yr, Guo Yg, Chu Xd, Sam LI, Pan Jh, Pan Yl. Relationship between Tertiary Lymphoid Structure and the Prognosis and Clinicopathologic Characteristics in Solid Tumors. Int J Med Sci 2021; 18(11):2327-2338. doi:10.7150/ijms.56347. Available from https://www.medsci.org/v18p2327.htm

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Abstract

Graphic abstract

Background: An increasing number of studies had shown that tertiary lymphoid structure (TLS) plays an important role in tumor progression. However, the prognostic role of TLS in various tumors remains controversial. This meta-analysis aims to investigate the clinicopathological and prognostic values of TLS in solid tumors.

Methods: A systematic search was conducted in PubMed, EMBASE and Cochrane Library undated to November 2, 2020. Odds ratios of clinical parameters, hazard ratio (HR) of overall survival (OS), relapse-free survival (RFS), disease-free survival (DFS) and relapse rate were calculated in order to evaluate the relationship between TLS expression and clinicopathological or prognostic values in different tumors.

Result: 27 eligible studies including 6647 patients with different types of tumors were analyzed. High TLS expression was associated with a longer OS (HR = 0.66, 95% CI: 0.50 - 0.86, P = 0.002) and RFS (HR = 0.61, 95% CI: 0.47 - 0.79, P = 0.0001). Moreover, high TLS levels in tumor were associated with a low risk of recurrence (HR = 0.43, 95% CI: 0.32 - 0.57, P < 0.0001). However, there was no relationship between TLS expression and DFS. Meanwhile, high TLS expression was associated with smaller tumor size (P < 0.00001) and higher tumor infiltrating lymphocytes (TILs). Furthermore, the subgroup analysis showed high TLS expression that may be associated with a lower clinical grading and N stage in breast cancer and colorectal cancer.

Conclusion: High TLS expression is associated with the longer OS and RFS in solid tumors, and a lower risk of cancer relapse. Meanwhile, high TLS expression is also associated with a smaller tumor size, higher infiltration of TILs, lower clinical grading and N stage in the tumor. Therefore, high TLS expression in the tumor is a favorable prognostic biomarker for solid tumor patients.

Keywords: tertiary lymphoid structure (TLS), tumor, overall survival, disease-free survival, relapse-free survival, clinicopathologic characteristics.