Tertiary lymphoid structures in pulmonary metastases of microsatellite stable colorectal cancer

Topias Karjula, Anne Niskakangas, Olli Mustonen, Iiris Puro, Hanna Elomaa, Maarit Ahtiainen, Teijo Kuopio, Jukka Pekka Mecklin, Toni T. Seppälä, Erkki Ville Wirta, Eero Sihvo, Fredrik Yannopoulos, Olli Helminen, Juha P. Väyrynen

Research output: Contribution to journalArticleScientificpeer-review

3 Citations (Scopus)
1 Downloads (Pure)


Tertiary lymphoid structures (TLSs) are ectopic lymphoid aggregates located at sites of chronic inflammation and recognized as prognosticators in several cancers. We aimed to analyse the prognostic effect of TLSs in colorectal cancer (CRC) pulmonary metastases and primary tumours, with a comparison to the CD3+ and CD8+ cell density-based immune cell score (ICS). For TLS density and TLS maximum diameter analysis, 67 pulmonary metastases and 63 primary tumours were stained with haematoxylin and eosin. For ICS scoring and analysis, CD3 and CD8 immunohistochemistry was performed. Excellent interobserver agreement was achieved in all TLS measurements. Of all patients, 36 patients had low TLS density (< 0.222 follicles/mm) and 31 patients had high TLS density (≥ 0.222 follicles/mm) in the first resected pulmonary metastases. TLS density (adjusted HR 0.91, 0.48–1.73) or maximum diameter (adjusted HR 0.78, 0.40–1.51) did not have prognostic value in pulmonary metastases. In primary tumours, higher TLS density (adjusted HR 0.39, 0.18–0.87) and maximum diameter (adjusted HR 0.28, 0.11–0.73) were associated with lower mortality. In the pulmonary metastases, ICS had superior prognostic value to TLSs; however, TLSs and ICS were significantly associated. In conclusion, TLSs in CRC pulmonary metastases had no prognostic value but correlated with the ICS. TLSs in primary tumours associated with favourable prognosis.

Original languageEnglish
Pages (from-to)21-32
Number of pages12
Issue number1
Publication statusPublished - 2023
Publication typeA1 Journal article-refereed


  • Microsatellite stable colorectal cancer
  • Pulmonary metastasis
  • Tertiary lymphoid structures

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Pathology and Forensic Medicine
  • Molecular Biology
  • Cell Biology


Dive into the research topics of 'Tertiary lymphoid structures in pulmonary metastases of microsatellite stable colorectal cancer'. Together they form a unique fingerprint.

Cite this