WCLC 2025 - Posters & ePosters-P2.08 .06 Clinical Significance of Tertiary Lymphoid Structures in Surgically Resected Stage II-III Lung Adenocarcinoma

P2.08 .06 Clinical Significance of Tertiary Lymphoid Structures in Surgically Resected Stage II-III Lung Adenocarcinoma

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This study investigated the clinical significance of tertiary lymphoid structures (TLS) in patients with pathological stage II–III lung adenocarcinoma, focusing on their association with prognosis and response to immune checkpoint inhibitors (ICI). TLS are lymphoid formations resembling secondary lymphoid organs that arise in response to inflammation or tumors and play roles in T cell activation, B cell antibody production, cytokine and chemokine-mediated immune cell recruitment, and lymphocyte infiltration.<br /><br />The analysis included 151 patients who underwent pulmonary resection between 2017 and 2020, classified as TLS-positive or TLS-negative based on histological identification of germinal centers in lymphoid follicles. Among these, 42 were TLS-positive and 109 TLS-negative. Survival outcomes demonstrated that TLS-positive patients had significantly longer relapse-free survival (RFS; 72.3 vs. 31.2 months) and overall survival (OS; not reached vs. 83.3 months) compared to TLS-negative patients. Multivariate analysis confirmed TLS positivity as an independent favorable prognostic factor. <br /><br />Additionally, 25 patients who received ICIs after recurrence were assessed. TLS-positive patients exhibited markedly better responses to ICIs, with a 75% objective response rate versus 0% in TLS-negative patients. Notably, TLS-positive patients benefited from ICIs even with low PD-L1 expression, suggesting TLS as a predictive biomarker for immunotherapy efficacy beyond PD-L1 status.<br /><br />The findings align with previous reports in lung and other cancers, underscoring TLS’s role in enhancing antitumor immunity and predicting therapeutic response. The study concludes that TLS presence in pathological stage II–III lung adenocarcinoma is a significant positive prognostic indicator and may guide immunotherapy decisions, especially for patients with low PD-L1 expression. This highlights TLS’s potential utility as both a prognostic and predictive biomarker in lung cancer management.

Asset Subtitle

Taiyo Nakamura

Meta Tag

Speaker Taiyo Nakamura

Topic Local-Regional Non-small Cell Lung Cancer

Keywords

tertiary lymphoid structures

TLS

lung adenocarcinoma

pathological stage II–III

immune checkpoint inhibitors

ICI

prognostic biomarker

predictive biomarker

relapse-free survival

PD-L1 expression