University of Oulu

Tahkola, K., Leppänen, J., Ahtiainen, M. et al. Virchows Arch (2019) 474: 691.

Immune cell score in pancreatic cancer-comparison of hotspot and whole-section techniques

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Author: Tahkola, Kyösti1,2; Leppänen, Joni3; Ahtiainen, Maarit4;
Organizations: 1Department of Surgery, Central Finland Central Hospital, Jyvaskyla, Finland
2Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Tampere, Finland
3Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
4Department of Education and Research, Central Finland Central Hospital and University of Eastern Finland, Jyvaskyla, Finland
5Department of Oncologic Pathology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
6Department of Pathology, Central Finland Central Hospital, Jyvaskyla, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Springer Nature, 2019
Publish Date: 2019-10-10


An immune cell score (ICS) was introduced for predicting survival in pancreatic ductal adenocarcinoma (PDAC). Few studies have compared different methods of evaluating immune infiltrate. This study compared ICSs determined in whole sections or tissue microarray-like hotspots for predicting survival after PDAC surgery. We included in 79 consecutive patients from a single geographical area that underwent surgery for PDAC (R0/R1, stages I–III). We performed digital image analyses to evaluate CD3 and CD8 staining. ICSs were classified as low, moderate, or high, based on the numbers of immune cells in the tumour core and invasive margin. We compared ICS groups determined with the hotspot and whole-section techniques. Associations between ICS and survival were analysed with Cox regression models, adjusted for sex, age, tumour stage, differentiation grade, perineural invasion, and resection radicality. In hotspot ICS analysis, 5-year overall survival rates for low, moderate, and high groups were 12.1%, 26.3%, and 26.8%, respectively (p = 0.193). In whole-section analyses, overall survival rates were 5.3%, 26.4%, and 43.8%, respectively (p = 0.030). In the adjusted Cox model, whole-section ICS groups were inversely associated with the overall mortality hazard ratio (HR): low, moderate, and high ICS groups had HRs of 1.00, 0.42 (95% CI 0.20–0.88), and 0.27 (95% CI 0.11–0.67), respectively. The number of immune cells per square millimetre in the tumour core and the invasive margin were significantly higher and had a wider range in hotspots than in whole-tissue sections. Accordingly, ICS could predict survival in patients with PDAC after surgery. Whole tissue section ICSs exhibited better prognostic value than hotspot ICSs.

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Series: Virchows Archiv. European journal of pathology
ISSN: 0945-6317
ISSN-E: 1432-2307
ISSN-L: 0945-6317
Volume: 474
Issue: 6
Pages: 691 - 699
DOI: 10.1007/s00428-019-02549-1
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
3111 Biomedicine
Funding: This work was supported by the Instrumentarium Science Foundation and by Finnish State Research Funding (VTR).
Copyright information: © The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.