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Tertiary lymphoid structures lower liver cancer recurrence risk

Intratumoral tertiary lymphoid structures correlated with a lower risk for early relapse of hepatocellular carcinoma after surgical resection, according to data published in Journal of Hepatology.

These results indicated that intratumoral tertiary lymphoid structures (TLS) may reflect the existence of an ongoing, effective antitumor immunity, according to Julien Calderaro, MD, PhD, from the University Hospital of Henri Mondor in France, and colleagues.

“TLS provide a local and important microenvironment for both cellular and humoral immune responses directed against neoplastic cells, and are considered as an indicator of favorable clinical outcome in virtually all human solid tumors,” Calderaro and colleagues wrote.

The researchers’ initial cohort included 273 patients who underwent surgical resection for HCC at their center between 1995 and 2016. Pathological examination showed TLS in 129 tumors. Researchers scored cases based on TLS maturation stages: Agg (tumors with ill-defined clusters of lymphocytes), FL-I (tumors with round-shaped lymphocytes without germinal center formation), or FL-II (tumors with follicles with germinal center formation). Among tumors with TLS, the maximum degree of TLS maturation was Agg in 72 patients, FL-I in 43 patients, and FL-II in 14 patients.

During follow-up, 113 patients experience HCC recurrence, including 83 early recurrences.

On univariate analysis, features associated with an increased risk for early recurrence included Barcelona-Clinic Liver Cancer stage B or C (P < .001), alpha-fetoprotein serum levels higher than 300 ng/mL (P < .001), hepatitis B (P = .006), tumor size larger than 50 mm (P < .001), satellite nodules (P < .001), microvascular invasion (P < .001), poor differentiation (P = .005), macrotrabecular-massive subtype (P < .001), positive surgical margin (P < .001), and TLS (P = .002).

TLS remained a significantly associated factor for decreased risk for early HCC relapse after multivariate analysis (HR = 0.46; 95% CI, 0.27-0.8).

Calderaro and colleagues also discovered that patients with either FL-I or FL-II had a lower risk for recurrence compared with patients with only Agg (P = .01). Women (P = .04) and patients with BCLC stage 0 or A (P = .01) were more likely to have intratumoral FL-I or FL-II.

“The number of tumors with FL-II was limited, and additional studies will be necessary to determine their prognostic significance compared to FL-I,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.