The Prognostic Significance of Tertiary Lymphoid Structure Assessment with Hematoxylin and Eosin Sections in Esophageal Squamous Cell Carcinoma

Abstract

Purpose To explore the potential prognostic prediction values of tertiary lymphoid structure (TLS) assessed using hematoxylin-eosin staining sections in esophageal squamous cell carcinoma（ESCC） Methods We conducted a comprehensive study involving 87 patients diagnosed with ESCC. Relevant clinicopathological data were collected. HE staining was performed to investigate the presence, density, diameter, and distribution of TLS within the cancerous regions. Subsequently, survival analysis using Kaplan–Meier and multivariable Cox regression analysis was executed to assess the prognostic significance of TLS profiles in ESCC patients. To corroborate our findings, we validated the results in an additional dataset comprising 84 ESCC patients obtained from the TCGA repository. Results We detected tertiary lymphoid structures (TLS) in 58 out of the 87 collected ESCC patients, mirroring the TCGA dataset where 44 out of 84 patients displayed TLS. The presence of TLS, coupled with their average density, diameter and distribution, demonstrated a correlation with prolonged survival in ESCC patients. However, upon adjusting for pathologic features, only the presence status of TLS emerged as an independent prognostic factor for long-term survival in ESCC, yielding a hazard ratio of 0.432 (P = 0.004). This observation was substantiated in the TCGA dataset with a hazard ratio of 0.359 (P = 0.028). This finding was validated in the TCGA data set with of hazard ratio of 0.359 (P = 0.028) Conclusion The routine evaluation of TLS presence in ESCC with HE staining appears to be feasible and could serve as an efficient biomarker for prognostic prediction.