University of Oulu

Kemi, N., Ylitalo, O., Väyrynen, J.P., Helminen, O., Junttila, A., Mrena, J., Böhm, J. and Kauppila, J.H. (2023), Tertiary lymphoid structures and gastric cancer prognosis. APMIS, 131: 19-25.

Tertiary lymphoid structures and gastric cancer prognosis

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Author: Kemi, Niko1; Ylitalo, Olli1; Väyrynen, Juha P.1,2;
Organizations: 1Cancer and Translational Medicine Research Unit, Medical Research Centre, University of Oulu and Oulu University Hospital, Oulu, Finland
2Department of Pathology, Central Finland Central Hospital, Jyväskylä, Finland
3Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
4Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: John Wiley & Sons, 2022
Publish Date: 2022-11-18


Tertiary lymphoid structures (TLSs) are part of immune response against cancer. Their high density and high diameter have been shown to be associated with prognosis in different cancer types. The aim of this study was to examine the prognostic significance of TLS density and diameter in gastric cancer and reproducibility of their assessments. TLS densities and maximal TLS diameter were assessed from hematoxylin–eosin (HE) stained slides of 721 surgically treated gastric cancer patients from two hospitals in Finland. Mortality hazard ratios (HRs) for TLS densities and maximal TLS diameter were analyzed. TLS densities and maximal TLS diameter were assessed with moderate interobserver agreement (Cohen’s kappa 0.50–0.62). Maximal TLS density was not associated with survival (adjusted HR 0.85, 95% CI 0.70–1.02) and neither was hotspot TLS density (adjusted HR 0.85, 95% CI 0.70–1.02). High maximal TLS diameter was associated with longer survival in overall study population (adjusted HR 0.74, 95% CI 0.61–0.89) and in diffuse type subgroup (adjusted HR 0.65, 95% CI 0.50–0.85). In conclusion, high maximal TLS diameter is associated with improved survival in gastric cancer and can be assessed from HE-stained slides. Its prognostic value might be limited to diffuse histological type.

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Series: APMIS
ISSN: 0903-4641
ISSN-E: 1600-0463
ISSN-L: 0903-4641
Volume: 131
Issue: 1
Pages: 19 - 25
DOI: 10.1111/apm.13277
Type of Publication: A1 Journal article – refereed
Field of Science: 3122 Cancers
Funding: This study was supported by grants from Vatsatautien tutkimussäätiö (NK), The Finnish Medical Foundation (NK), Sigrid Jusélius Foundation (JHK), Finnish Cancer Foundation (JHK), Orion Research Foundation (JHK), Thelma Mäkikyrö Foundation (JHK), Mary and Georg C. Ehrnroot Foundation (JHK, OH), and Instrumentarium Science Foundation (OH).
Copyright information: © 2022 The Authors. APMIS published by John Wiley & Sons Ltd on behalf of Scandinavian Societies for Pathology, Medical Microbiology and Immunology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.