乳腺外佩吉特病中三级淋巴结构的临床和病理意义。
The clinical and pathological significance of tertiary lymphoid structure in extramammary Paget's disease.
作者信息
Xi Ningyuan, Xu Xiaoxiang, Xu Mingyuan, Wu Nanhui, Wu Yuhao, Chen Jiashe, Liu Shuyi, Jiang Long, Yan Guorong, Zhang Guolong, Liu Yeqiang
机构信息
Department of Pathology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Phototherapy, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.
出版信息
Front Immunol. 2024 Nov 15;15:1435629. doi: 10.3389/fimmu.2024.1435629. eCollection 2024.
BACKGROUND
Tumor-associated tertiary lymphoid structures (TLSs) are functional immune-responsive aggregates, which have been reported to be associated with better prognosis in various tumors. However, their exact characteristics and prognostic value in extramammary Paget's disease (EMPD) remain unknown.
OBJECTIVE
To explore the features of TLSs in EMPD and their association with clinicopathological characteristics.
METHODS
In total, 171 EMPD patients from 2015 to 2023, retrospective, single center cohort were collected to assess the presence, maturation status, and location of TLSs by immunohistochemistry. Then, their clinicopathologic association and prognostic significance were further examined.
RESULTS
TLSs were detected in 97 cases (57%) of 171 EMPD patients, including high-density TLSs in 88 cases (91%), peritumoral TLSs (pTLSs) in 89 cases (92%), TLSs around appendages (aTLSs) in 23 cases (24%), and mature TLSs in 16 cases (16%). Secondary EMPD was more likely to produce TLS (Secondary: 16/21 [76%]; Primary: 81/150 [54%]; = 0.06), and more likely to produce Mature TLS (Secondary: 5/10 [50%]; Primary: 11/80 [14%]; = 0.02). The subjective symptoms of EMPD patients did not seem to correlate with the presence of TLS. EMPD patients with tumor invasion were more likely to form mature TLS (Invasion: 8/32 [25%]; : 8/65 [12%]; = 0.06), recurrent EMPD patients were more likely to form TLS (Recurrent: 34/50 [68%]; Initial: 63/121 [52%]; = 0.06) especially mature TLS (Recurrent: 8/34 [24%]; Initial: 8/63 [13%]; = 0.04). The depth of tumor invasion in EMPD patients with mature TLS was mostly less than or equal to 4mm (mature TLS+: 7/8 [88%]; TLS-: 6/17 [35%]; = 0.05), aTLS were less common in EMPD patients with skin appendage invasion (aTLS+: 4/23 [17%]; aTLS-: 32/74 [43%]; = 0.03). The same EMPD patients relapse after, the existence of TLS increased [TLS+ (initial): 9/17 (53%); TLS+ (recurrence):14/17 (82%); =.07].
LIMITATIONS
Retrospective study design.
CONCLUSIONS
Mature TLS is a positive prognostic factor for invasive EMPD and may serve as a new biomarker and therapeutic target for EMPD.
背景
肿瘤相关三级淋巴结构（TLSs）是功能性免疫反应性聚集物，据报道在各种肿瘤中与较好的预后相关。然而，它们在乳腺外佩吉特病（EMPD）中的确切特征和预后价值仍不清楚。
目的
探讨EMPD中TLSs的特征及其与临床病理特征的关系。
方法
收集2015年至2023年共171例EMPD患者，进行回顾性单中心队列研究，通过免疫组织化学评估TLSs的存在、成熟状态和位置。然后，进一步研究它们的临床病理相关性和预后意义。
结果
171例EMPD患者中有97例（57%）检测到TLSs，其中88例（91%）为高密度TLSs，89例（92%）为肿瘤周围TLSs（pTLSs），23例（24%）为附件周围TLSs（aTLSs），16例（16%）为成熟TLSs。继发性EMPD更易产生TLS（继发性：16/21 [76%]；原发性：81/150 [54%]；P = 0.06），且更易产生成熟TLS（继发性：5/10 [50%]；原发性：11/80 [14%]；P = 0.02）。EMPD患者的主观症状似乎与TLS的存在无关。肿瘤侵犯的EMPD患者更易形成成熟TLS（侵犯：8/32 [25%]；无侵犯：8/65 [12%]；P = 0.06），复发性EMPD患者更易形成TLS（复发：34/50 [68%]；初发：63/121 [52%]；P = 0.06），尤其是成熟TLS（复发：8/34 [24%]；初发：8/63 [13%]；P = 0.04）。有成熟TLS的EMPD患者肿瘤侵犯深度大多小于或等于4mm（成熟TLS+：7/8 [88%]；TLS-：6/17 [35%]；P = 0.05），皮肤附件侵犯的EMPD患者中aTLS较少见（aTLS+：4/23 [17%]；aTLS-：32/74 [43%]；P = 0.03）。同一EMPD患者复发后，TLS的存在增加[TLS+（初发）：9/17（53%）；TLS+（复发）：14/17（82%）；P = 0.07]。
局限性
回顾性研究设计。
结论
成熟TLS是侵袭性EMPD的阳性预后因素，可能成为EMPD的新生物标志物和治疗靶点。
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