The prognostic significance of desmoplastic reaction, tumor budding and tumor-infiltrating lymphocytes in esophageal squamous cell carcinomas.

BACKGROUND

Recent research has demonstrated the importance of the tumor microenvironment (TME) in the behavior of solid tumors. Numerous discoveries suggest that tumor progression in a variety of malignancies, including those of the gastrointestinal tract, may be predicted by pathological evaluation of the desmoplastic reaction (DR), tumor budding (TB) and tumor-infiltrating lymphocytes (TIL). While some studies have demonstrated the prognostic impact of TIL in patients with squamous cell carcinoma of the esophagus (ESCC), the data have not reached agreement. Furthermore, few studies have investigated the relationship of DR and TB with disease progression. The relationships between DR, TB and TIL in these tumors remain to be investigated. Therefore, this study was undertaken to explore the relationships between DR, TB and TIL and histopathological parameters related to tumor behavior and assess their prognostic role in predicting survival in patients with ESCC.

METHODS

The retrospective case series included 98 patients diagnosed with ESCC. DR was assessed on the basis of the maturation of the tumor stroma. TB was evaluated according to the International Tumor Budding Conference (ITBCC) criteria. A semiquantitative method with a 5% threshold value was used to evaluate TIL.

RESULTS

A significant correlation was identified between DR and sex (p = 0.023) and between DR and depth of invasion (T) (p = 0.006). TB and TIL were correlated with T (p < 0.001 and p = 0.002), lymph node metastasis (LNM) (p = 0.006 and p = 0.018), tumor stage (p < 0.001) and p = 0.003). Although DR was significantly positively correlated with TB (p < 0.001), no correlation was detected with TIL. A negative correlation between TIL and TB was also observed (p = 0.04). The results of the univariate analysis revealed significant correlations between poor survival rates and T (p < 0.001), LNM (p = 0.002), stage (p < 0.001), DR (p < 0.001), TB (p < 0.001), and TIL (p = 0.009). The multivariate analysis revealed that DR (p < 0.001), TB (p < 0.001), and T (p < 0.001) were independent prognostic factors.

CONCLUSION

Our study emphasized that the assessment of DR and TB can be used to categorize individuals with ESCC for therapy and prognosis. Further research is needed to clarify the prognostic roles of TIL and their subtypes in ESCC and how they are associated with DR, depending on their association with TB.