Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
Oncologist. 2024 Feb 2;29(2):e248-e258. doi: 10.1093/oncolo/oyad283.
To evaluate the presence and subtypes of tertiary lymphatic structures (TLSs) in urothelial carcinoma of the bladder (UCB) and to analyze their associated clinicopathological characteristics and prognostic significance.
The study enrolled 580 patients with surgically treated UCB, including 313 non-muscle invasive bladder cancer (NMIBC) and 267 muscle-invasive bladder cancer (MIBC). The presence and subtypes of TLSs were identified by immunohistochemistry (CD20, CD3, Bcl-6, and CD21). TLSs were classified into non-GC (nGC) TLS and GC TLS subtypes based on germinal center (GC) formation. Disease-free survival (DFS) was used as an endpoint outcome to evaluate the prognostic significance of TLS and its subtypes in UCB.
TLSs were more common in MIBC than in NMIBC (67.8% vs 48.2%, P < .001), and the tumor-infiltrating lymphocyte (TIL) mean density was significantly higher in MIBC than in NMIBC (24.0% vs 17.5%, P < .001). Moreover, a positive correlation was found between TLS presence and GC structure formation and TIL infiltration in UCB. Endpoint events occurred in 191 patients. Compared to patients with endpoint events, patients without disease progression exhibited higher TIL density and more TLSs (P < .05). Kaplan-Meier curves showed that TLS was associated with better DFS in NMIBC (P = .041) and MIBC (P = .049). However, the Cox multivariate analysis did not demonstrate the prognostic significance of TLS.
TLS is heterogeneous in UCB, and that TLS and GC structures are related to TIL density and prognostic events. However, TLS as a prognostic indicator remains unclear, warranting further investigation.
评估膀胱癌（UCB）中三级淋巴结构（TLSs）的存在和亚型，并分析其与临床病理特征的关联及其预后意义。
本研究纳入了 580 例接受手术治疗的 UCB 患者，包括 313 例非肌层浸润性膀胱癌（NMIBC）和 267 例肌层浸润性膀胱癌（MIBC）。通过免疫组织化学（CD20、CD3、Bcl-6 和 CD21）鉴定 TLSs 的存在和亚型。根据生发中心（GC）形成，将 TLS 分为非 GC（nGC）TLS 和 GC TLS 亚型。以无病生存期（DFS）作为终点事件，评估 TLS 及其在 UCB 中的亚型的预后意义。
TLS 在 MIBC 中比在 NMIBC 中更为常见（67.8%比 48.2%，P<0.001），MIBC 中的肿瘤浸润淋巴细胞（TIL）平均密度明显高于 NMIBC（24.0%比 17.5%，P<0.001）。此外，在 UCB 中，TLS 的存在与 GC 结构形成和 TIL 浸润之间存在正相关关系。191 例患者发生终点事件。与发生疾病进展的患者相比，未发生疾病进展的患者具有更高的 TIL 密度和更多的 TLS（P<0.05）。Kaplan-Meier 曲线显示，TLS 与 NMIBC（P=0.041）和 MIBC（P=0.049）的更好的 DFS 相关。然而，Cox 多变量分析未显示 TLS 的预后意义。
TLS 在 UCB 中具有异质性，TLS 和 GC 结构与 TIL 密度和预后事件相关。然而，TLS 作为预后指标仍不明确，需要进一步研究。
