Localization and density of tertiary lymphoid structures associate with molecular subtype and clinical outcome in colorectal cancer liver metastases

• DOI: 10.1136/jitc-2022-006425
• Publication Date: 2023-02-09T15:01:22Z
• Authors: Chong Zhang; Xiang-Yu Wang; Jie-Liang Zuo; Xue-Fu Wang; Xiao-Wen Feng; Bo Zhang; Yi-Tong Li; Chen-He Yi; Peng Zhang; Xiao-Chen Ma; Zhen-Mei Chen; Yue Ma; Jia-Hao Han; Bao-Rui Tao; Rui Zhang; Tian-Qi Wang; Li Tong; Wang Gu; Si-Yu Wang; Xiao-Fei Zheng; Wen-Kang Yuan; Zi-Jie Kan; Jie Fan; Xiang-Yang Hu; Jun Li; Chao Zhang; Jin-Hong Chen
• Keywords: Liver Neoplasms; Neoplasms. Tumors. Oncology. Including cancer and carcinogens; 3. Good health; 03 medical and health sciences; Tertiary Lymphoid Structures; Lymphocytes, Tumor-Infiltrating; 0302 clinical medicine; Immunotherapy Biomarkers; Humans; Neoplasm Recurrence, Local; Colorectal Neoplasms; RC254-282

BackgroundTertiary lymphoid structures (TLSs) have been proposed to assess the prognosis of patients with cancer. Here, we investigated the prognostic value and relevant mechanisms of TLSs in colorectal cancer liver metastases (CRCLM).Methods603 patients with CRCLM treated by surgical resection from three cancer centers were included. The TLSs were categorized according to their anatomic subregions and quantified, and a TLS scoring system was established for intratumor region (T score) and peritumor region (P score). Differences in relapse-free survival (RFS) and overall survival (OS) between groups were determined. Multiplex immunohistochemical staining (mIHC) was used to determine the cellular composition of TLSs in 40 CRCLM patients.ResultsT score positively correlated with superior prognosis, while P score negatively associated with poor survival (all p<0.05). Meanwhile, T score was positively associated with specific mutation subtype of KRAS. Furthermore, TLSs enrichment gene expression was significantly associated with survival and transcriptomic subtypes of CRCLM. Subsequently, mIHC showed that the densities of Treg cells, M2 macrophages and Tfh cells were significantly higher in intratumor TLSs than in peritumor TLSs (p=0.029, p=0.047 and p=0.041, respectively), and the frequencies of Treg cells and M2 macrophages were positively correlated with P score, while the frequencies of Tfh cells were positively associated with T scores in intratumor TLSs (all p<0.05). Next, based on the distribution and abundance of TLSs, an Immune Score combining T score and P score was established which categorized CRCLM patients into four immune classes with different prognosis (all p<0.05). Among them, patients with higher immune class have more favorable prognoses. The C-index of Immune Class for RFS and OS was higher than Clinical Risk Score statistically. These results were also confirmed by the other two validation cohorts.ConclusionsThe distribution and abundance of TLSs is significantly associated with RFS and OS of CRCLM patients, and a novel immune class was proposed for predicting the prognosis of CRCLM patients.