University of Oulu

Alhadi Almangush, Miia Ruuskanen, Jaana Hagström, Pasi Hirvikoski, Satu Tommola, Veli-Matti Kosma, Pentti Nieminen, Antti Mäkitie, Ilmo Leivo, Tumor-infiltrating lymphocytes associate with outcome in nonendemic nasopharyngeal carcinoma: a multicenter study, Human Pathology, Volume 81, 2018, Pages 211-219, ISSN 0046-8177,

Tumor-infiltrating lymphocytes associate with outcome in nonendemic nasopharyngeal carcinoma : a multicenter study

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Author: Almangush, lhadi1,2,3; Ruuskanen, Miia4; Hagström, Jaana1,5,6;
Organizations: 1Department of Pathology, University of Helsinki, P.O. Box 21, Helsinki, Finland
2University of Turku, Institute of Biomedicine, Pathology, P.O. Box 20520, Turku, Finland
3Institute of Dentistry, University of Misurata, P.O. Box 2478 Misurata, Libya
4Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital and University of Turku, P.O. Box 52, 20521 Turku, Finland
5HusLab, Helsinki University Hospital, P.O. BOX 100, FI-00029 Helsinki, Finland
6Research Programs Unit, Translational Cancer Biology, University of Helsinki, FI-00290 Helsinki, Finland
7Department of Pathology, Oulu University Hospital, P.O. Box 10, 90029 Oulu, Finland
8Department of Pathology, Fimlab Laboratories, PO Box 66, FI-33101 Tampere, Finland
9School of Medicine, Institute of Clinical Medicine, Pathology and Forensic Medicine, and Cancer Center of Eastern Finland, University of Eastern Finland, P.O. Box 1627, Kuopio, Finland
10Imaging Center, Clinical Pathology, Kuopio University Hospital, P.O. Box 100, Kuopio, Finland
11Medical Informatics and Statistics Research Group, University of Oulu, P.O. Box 5000, FI-90014 Oulu, Finland
12Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O.Box 263, FI-00029 Helsinki, Finland
13Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 13.9 MB)
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Language: English
Published: Elsevier, 2018
Publish Date: 2019-07-18


The prognostic significance of tumor-infiltrating lymphocytes (TILs) has been studied recently in many cancers. For the first time in a nonendemic region, we have evaluated the prognostic value of TILs in a whole population–based nationwide cohort of nasopharyngeal carcinoma (NPC) in Finland. A total of 115 cases from Finnish hospitals were included. TILs were analyzed using hematoxylin and eosin–stained slides according to the criteria of the International Immuno-Oncology Biomarker Working Group. TILs were evaluated separately in stromal and tumor compartments. The log-rank test and univariable and multivariable analyses were used to compare survival in patients with tumors with low and high TILs. A significant positive correlation was observed between the occurrence of intratumoral and stromal TILs (P < .001). In multivariable analysis, NPC cases with low intratumoral TILs had poor overall survival with a hazard ratio (HR) of 2.55 and 95% confidence interval (95% CI) of 1.60 to 4.05 (P < .001). Cases with low intratumoral TILs also had poor disease-specific survival (HR, 2.02; 95% CI, 1.16–3.52; P = .015). Keratinized tumors with low intratumoral TILs were associated with an even poorer overall survival (HR, 3.94; 95% CI, 2.17–7.15; P < .001) and a poor disease-specific survival (HR, 2.97; 95% CI, 1.46–6.05; P = .009). Our study demonstrates that the evaluation of TILs is simple and can be assessed routinely in NPC.

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Series: Human pathology
ISSN: 0046-8177
ISSN-E: 1532-8392
ISSN-L: 0046-8177
Volume: 81
Pages: 211 - 219
DOI: 10.1016/j.humpath.2018.07.009
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Copyright information: © 2018. This manuscript version is made available under the CC-BY-NC-ND 4.0 license