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Integrated analysis of tertiary lymphoid structures in relation to tumor-infiltrating lymphocytes and patient survival in pancreatic ductal adenocarcinoma

  • Original Article―Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Tertiary lymphoid structure (TLS) reflects an intense immune response against cancer, which correlates with favorable patient survival. However, the association of TLS with tumor-infiltrating lymphocytes (TILs) and clinical outcomes has not been investigated comprehensively in pancreatic ductal adenocarcinoma (PDAC).

Methods

We utilized an integrative molecular pathological epidemiology database on 162 cases with resected PDAC, and examined TLS in relation to levels of TILs, patient survival, and treatment response. In whole-section slides, we assessed the formation of TLS and conducted immunohistochemistry for tumor-infiltrating T cells (CD4, CD8, CD45RO, and FOXP3). As confounding factors, we assessed alterations of four main driver genes (KRAS, TP53, CDKN2A [p16], and SMAD4) using next-generation sequencing and immunohistochemistry, and tumor CD274 (PD-L1) expression assessed by immunohistochemistry.

Results

TLSs were found in 112 patients with PDAC (69.1%). TLS was associated with high levels of CD4+ TILs (multivariable odds ratio [OR], 3.50; 95% confidence interval [CI] 1.65–7.80; P = 0.0002), CD8+ TILs (multivariable OR, 11.0; 95% CI 4.57–29.7, P < 0.0001) and CD45RO+ TILs (multivariable OR, 2.65; 95% CI 1.25–5.80, P = 0.01), but not with levels of FOXP3+ TILs. TLS was associated with longer pancreatic cancer-specific survival (multivariable hazard ratio, 0.37; 95% CI 0.25–0.56, P < 0.0001) and favorable outcomes of adjuvant S-1-treatment. TLS was not associated with driver gene alterations but tumor CD274 negative expression.

Conclusions

Our comprehensive data supports the surrogacy of TLS for vigorous anti-tumor immune response characterized by high levels of helper and cytotoxic T cells and their prognostic role.

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Data availability

The sequence data reported are available in the DNA Data Bank of Japan (DDBJ) Sequenced Read Archive under the accession number DRA011317.

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Acknowledgements

The authors would like to thank Takashi Omori (Clinical & Translational Research Center, Kobe University), Nobuyuki Kakiuchi (Department of Pathology and Tumor Biology, Kyoto University) and Yohei Masugi (Department of Pathology, Keio University School of Medicine) for their valuable comments. We would like to thank Editage (www.edita ge.jp) for the English language editing.

Funding

This work was supported by JSPS KAKENHI (Grants-in-Aid for Scientific Research), Grant no. 19K08444 (A.M.), and Grant no. 19H03698 (Y.K.). This work was also supported by Pancreas Research Foundation of Japan (A.M.).

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Authors and Affiliations

  1. Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Takeshi Tanaka, Atsuhiro Masuda, Jun Inoue, Takuya Ikegawa, Hideyuki Shiomi, Arata Sakai, Takashi Kobayashi, Shunta Tanaka, Ryota Nakano, Yasutaka Yamada, Shigeto Ashina, Masahiro Tsujimae, Kohei Yamakawa, Shohei Abe, Masanori Gonda, Shigeto Masuda, Noriko Inomata, Hisahiro Uemura, Shinya Kohashi, Kae Nagao, Yoshihide Ueda & Yuzo Kodama

  2. Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-5-1 Kusunoki-Cho, Chuo-Ku, Tokyo, 113-8655, Japan

    Tsuyoshi Hamada

  3. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Hirochika Toyama & Takumi Fukumoto

  4. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Keitaro Sofue

  5. Division of Diagnostic Pathology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-Cho, Chuo-Ku, Kobe, Hyogo, 650-0017, Japan

    Maki Kanzawa & Tomoo Itoh

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  1. Takeshi Tanaka
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by TT, JI, TI, ST, RN, YY, SA, MT, KY, SA, MG, SM, NI, HU, SK and KN. The first draft of the manuscript was written by TT, and AM designed the study concept, analyzed data, and wrote the manuscript. MK and TI reviewed all slides in the study and advised on pathological diagnosis as needed. TH, HT, KS, HS, AS, TK, YU, TF and YK were involved in study supervision and revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Atsuhiro Masuda.

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535_2022_1939_MOESM1_ESM.tif

Supplementary Fig. 1 Representative immuno-histochemistry images. a Typical images of high or low levels of CD4+, CD8+, CD45RO+ and FOXP3+ TILs. b Typical images of presence or absence of CD274 (PD-L1) expression. c Typical images of intact or altered (lost or over expression) of protein expression of TP53, CDKN2A and SMAD4. Original magnification (a-c, 200×). Scale bars, 50 μm (a-c). PDL1, Programmed death ligand 1; TILs, tumor-infiltrating lymphocytes

535_2022_1939_MOESM2_ESM.tif

Supplementary Fig. 2 CSS of PDAC patients according to the intratumoral TLS and peritumoral TLS. Intratumoral TLSs were detected within and around the tumor; peritumoral TLSs were detected only around the tumor. The CSS curves were estimated using the Kaplan–Meier method, and the significant differences between the two groups were evaluated using a log-rank test. The number of patients at risk is shown in the CSS curves. CSS, cancer-specific survival; PDAC, pancreatic ductal adenocarcinoma; TLS, tertiary lymphoid structure

535_2022_1939_MOESM3_ESM.tif

Supplementary Fig. 3 CSS of PDAC patients according to the level of NLR or extent of CD8+ TILs. The CSS of PDAC patients according to high or low NLR were investigated. The differences of the CSS in adjuvant chemotherapy among the groups treated with S-1, gemcitabine, and non-treated groups according to the high or low NLR were also examined. a All patients b Patients with low NLR c Patients with high NLR. The CSS of PDAC according to the high or low levels of CD8+ TILs were investigated. The differences of the CSS in adjuvant chemotherapy among the groups treated with S-1, gemcitabine, and non-treated groups according to the high or low levels of CD8+ TILs were also examined. d All patients e Patients with high levels of CD8+ TILs f Patients with low levels of CD8+ TILs. The CSS curves were estimated using the Kaplan-Meier method, and the significant differences between the two groups were evaluated by a log-rank test. The number of patients at risk is shown in the CSS curves. CSS, cancer-specific survival; NLR, neutrophil-to lymphocyte ratio; PDAC, pancreatic ductal adenocarcinoma; TILs, tumor-infiltrating lymphocytes

535_2022_1939_MOESM4_ESM.tif

Supplementary Fig. 4 In situ hybridization for IFN-gamma and IL-2, and apoptosis assay. a Typical images of IFN-gamma and IL-2 expression in TLS- present and absent patients. IFN-gamma-positive cells and IL-2-positive cells show distinct red staining. b The expression levels of IFN-gamma or IL-2 per cm2 in TLS-present patients (n=5) and TLS-absent patients (n=5) were counted. Mean ± SD (bars). *, P < 0.05. c Double immunohistochemistry-in situ hybridization. To distinguish between IHC of CD4+ and CD8+ T cells (brown) and ISH of IFN-gamma (pink) more clearly, brown is changed to green using color replacement tools of Photoshop. IFN-gamma mRNA (pink arrowhead) was localized to CD4+ and CD8+ T cells (green). d TUNEL assays were performed 7 days after the addition of IFN-gamma (100 units/mL), IL-2 (500 units/ml), 5-FU (0.05 mg/mL), and their combination to detect the apoptotic cells. TUNEL analysis showed a significant difference in cell numbers at day 7 between the combination therapy group and other treatment groups. Mean ± SD (bars). **, P < 0.001, ***, P < 0.01. Original magnification (a, c, 400×). Scale bars, 20 μm. IFN, interferon; IL, interleukin; PDAC, pancreatic ductal adenocarcinoma; SD, standard deviation; TLS, tertiary lymphoid structure

Supplementary file5 (DOCX 59 KB)

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Tanaka, T., Masuda, A., Inoue, J. et al. Integrated analysis of tertiary lymphoid structures in relation to tumor-infiltrating lymphocytes and patient survival in pancreatic ductal adenocarcinoma. J Gastroenterol 58, 277–291 (2023). https://doi.org/10.1007/s00535-022-01939-8

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