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中华普外科手术学杂志(电子版) ›› 2026, Vol. 20 ›› Issue (06) : 541 -546. doi: 10.3877/cma.j.issn.1674-3946.2026.06.009

论著

结肠癌组织内TLS成熟度与临床病理特征及预后的关系研究
杨件新1, 姚宁华2, 郑菲菲3,†()   
  1. 1 226200 江苏 南通,南通大学附属启东医院普外科胃肠外科
    2 226001 江苏 南通,南通大学附属医院肿瘤放疗科
    3 224002 江苏 无锡,江南大学附属医院检验科
  • 收稿日期:2026-02-23 出版日期:2026-12-26
  • 通信作者: 郑菲菲

Study on the relationship between TLS maturity in colon cancer tissues and clinical pathological characteristics as well as prognosis

Jianxin Yang1, Ninghua Yao2, Feifei Zheng3,†()   

  1. 1 Department of General Surgery and Gastrointestinal Surgery, Qidong Hospital Affiliated to Nantong University, Nantong Jiangsu Province 226200, China
    2 Department of Radiation Oncology, Affiliated Hospital of Nantong University, Nantong Jiangsu Province 226001, China
    3 Department of Laboratory Medicine, Affiliated Hospital of Jiangnan University, Wuxi Jiangsu Province 224002, China
  • Received:2026-02-23 Published:2026-12-26
  • Corresponding author: Feifei Zheng
  • Supported by:
    Life Oasis Cancer Research Fund Project(BH004506)
引用本文:

杨件新, 姚宁华, 郑菲菲. 结肠癌组织内TLS成熟度与临床病理特征及预后的关系研究[J/OL]. 中华普外科手术学杂志(电子版), 2026, 20(06): 541-546.

Jianxin Yang, Ninghua Yao, Feifei Zheng. Study on the relationship between TLS maturity in colon cancer tissues and clinical pathological characteristics as well as prognosis[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(06): 541-546.

目的

研究结肠癌组织内三级淋巴结构(TLS)成熟度与临床病理特征及预后的关系。

方法

回顾性分析2022年1月至2024年1月162例结肠癌患者的临床资料,依据肿瘤间质区是否存在TLS,分为TLS阳性组(n=124)和TLS阴性组(n=38),将TLS阳性组进一步依据TLS的组织学形态及功能结构完整性,分为成熟型TLS(SFL-TLS)组(n=65)和未成熟型TLS(非SFL-TLS)组(n=59)。收集患者基线资料,通过组织病理及免疫组织化学法评估TLS结构,生存差异采用Kaplan-Meier法及Log-Rank检验分析,影响总生存期(OS)的独立因素采用多因素Cox比例风险回归分析。

结果

术前,TLS阳性组与TLS阴性组患者癌胚抗原(CEA)水平的组间差异具有统计学意义(P<0.05);SFL-TLS组与非SFL-TLS组微卫星不稳定(MSI)状态及淋巴结包膜外侵犯的组间差异具有统计学意义(P<0.05),SFL-TLS组效应性免疫细胞(CD8+T细胞、NK细胞、CD8+细胞毒性T细胞、CD20+B细胞)及CXCL13趋化因子水平显著高于非SFL-TLS组,抑制性Treg细胞水平显著低于非SFL-TLS组(P<0.001);TLS阳性组患者3年OS为63.7%(79/124),TLS阴性组为42.1%(16/38),两组间差异具有统计学意义(Log-Rank χ2=6.785,P=0.009);SFL-TLS组患者3年OS为76.9%(50/65),非SFL-TLS组3年OS为49.2%(29/59),两组间差异具有统计学意义(Log-Rank χ2=10.422,P=0.001);Cox单因素分析显示:术前CEA水平、淋巴结包膜外侵犯是患者OS的危险因素;MSI状态、TLS成熟度是患者OS的保护因素;多因素Cox分析进一步提示:术前CEA水平(HR: 1.027, 95%CI: 1.000~1.055)、淋巴结包膜外侵犯(HR: 2.583, 95%CI: 1.382~4.825)是患者OS的独立危险因素;MSI状态(HR: 0.452, 95%CI: 0.239~0.853)、TLS成熟度(HR: 0.372, 95%CI: 0.192~0.713)是患者OS的独立保护因素,TLS存在状态未体现独立的预后影响。

结论

TLS成熟度与微卫星高度不稳定状态相关,是患者OS的独立保护因素,并可作为评估结肠癌患者预后的潜在生物指标。

Objective

To investigate the relationship between the maturity of tertiary lymphoid structures (TLS) in colon cancer tissues and clinical pathological features as well as prognosis.

Methods

The clinical data of 162 patients with colon cancer from January 2022 to January 2024 were retrospectively analyzed. The patients were divided into the TLS-positive group (n=124) and the TLS-negative group (n=38) based on the presence or absence of TLS in the tumor stroma. The TLS-positive group was further divided into the mature TLS (SFL-TLS) group (n=65) and the immature TLS (non-SFL-TLS) group (n=59) according to the histological morphology and functional structure integrity of TLS. Baseline data of the patients were collected, and the TLS structure was evaluated by histopathology and immunohistochemistry. Survival differences were analyzed using the Kaplan-Meier method and Log-Rank test. Independent factors affecting overall survival (OS) were analyzed using multivariate Cox proportional hazards regression.

Results

Before surgery, there was a statistically significant difference in the preoperative carcinoembryonic antigen (CEA) levels between the TLS-positive group and the TLS-negative group (P<0.05); there were statistically significant differences in microsatellite instability (MSI) status and extranodal lymph node invasion between the SFL-TLS group and the non-SFL-TLS group (P<0.05). The effector immune cells (CD8+ T cells, NK cells, CD8+ cytotoxic T cells, CD20+ B cells) and CXCL13 chemokine levels in the SFL-TLS group were significantly higher than those in the non-SFL-TLS group, while the inhibitory Treg cell levels were significantly lower than those in the non-SFL-TLS group (P<0.001); the 3-year OS of the TLS-positive group was 63.7% (79/124), and that of the TLS-negative group was 42.1% (16/38), with a statistically significant difference between the two groups (Log-Rank χ2=6.785, P=0.009); the 3-year OS of the SFL-TLS group was 76.9% (50/65), and that of the non-SFL-TLS group was 49.2% (29/59), with a statistically significant difference (Log-Rank χ2=10.422, P=0.001); Cox univariate analysis showed that the preoperative cancer antigen (CEA) level and extranodal lymph node invasion were risk factors for OS; the MSI status and maturity of TLS were protective factors for the overall survival of patients; multivariate Cox analysis further indicated that the preoperative CEA level (HR: 1.027, 95%CI: 1.000~1.055), extranodal lymph node invasion (HR: 2.583, 95%CI: 1.382~4.825) were independent risk factors for OS; the MSI status (HR: 0.452, 95%CI: 0.239~0.853), TLS maturity (HR: 0.372, 95%CI: 0.192~0.713) were independent protective factors for OS, while the TLS presence status did not show an independent prognostic impact.

Conclusion

The maturity of TLS is related to the high microsatellite instability status and is an independent protective factor for OS in patients with colon cancer, and it can be used as a potential biomarker for evaluating the prognosis of colon cancer patients.

图1 三级淋巴结构(TLS)的病理组织学形态 A红色箭头指向为瘤周成熟型TLS(HE染色)镜下可见典型次级滤泡(生发中心)结构,伴滤泡周边T细胞聚集区;B红色箭头指向为瘤周未成熟型TLS(HE染色)镜下可见B、T淋巴细胞混合聚集,未形成明确生发中心及有序分区
表1 TLS阳性组患者与TLS阴性组患者基线资料比较
表2 SFL-TLS组与非SFL-TLS组患者基线资料比较
表3 TLS成熟度与临床病理特征的相关性分析
图2 三级淋巴结构(TLS)相关亚组结肠癌患者总生存期的Kaplan-Meier生存曲线图 A为TLS阴性组与TLS阳性组结肠癌患者总生存期的Kaplan-Meier生存曲线;B为成熟型TLS(SFL-TLS)组与未成熟型TLS(非SFL-TLS)组结肠癌患者总生存期的Kaplan-Meier生存曲线
表4 TLS成熟度及临床病理因素对结肠癌患者总生存期的Cox回归分析
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