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Hülsen S, Lippolis E, Ferrazzi F, Otto W, Distel L, Fietkau R, Denzinger S, Breyer J, Burger M, Bertz S, Eckstein M, Ebner A, Hartmann A, Geppert CI. High Stroma T-Cell Infiltration is Associated with Better Survival in Stage pT1 Bladder Cancer. Int J Mol Sci 2020; 21:ijms21218407. [PMID: 33182484 PMCID: PMC7665154 DOI: 10.3390/ijms21218407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/30/2020] [Accepted: 11/04/2020] [Indexed: 12/24/2022] Open
Abstract
Stage pT1 bladder cancer (BC) shows highly diverse outcomes. Predictive markers are required to stratify patients for personalized treatment. The present study aimed to validate immune response quantification as a prognostic marker. Patients with pT1 BC (n = 167) treated by transurethral resection of the bladder (TURB) were enrolled. Formaldehyde-fixed paraffin-embedded material was stained for CD3 and CD8. Corresponding T cells were counted in three regions with the highest immune response. Numbers of tertiary lymphoid structures (TLS) and lymphocyte aggregates (LA) were quantified. High CD3+ stroma T-cell infiltration was associated with improved survival (p = 0.045), especially in the G3 subgroup (p = 0.01). Cluster with higher immune response showed less recurrence (p = 0.034) and favorable overall survival (OS) (p = 0.019). In contrast, higher CD3+ and CD8+ tumor T-cell infiltration seemed to have a negative impact on prognosis. TLS and LA were more frequently observed in G3 tumors, indicating an increased anti-tumoral immune response. We proved the role of immune cell infiltration and showed that higher infiltration numbers of CD3+ (not CD8+) lymphocytes in the stroma are associated with favorable outcome. Immune cell quantification could be used as a marker to help stratify patients’ risk and therefore, to optimize patients’ management and follow-up examination as well as possible therapies.
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Affiliation(s)
- Sabine Hülsen
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
| | - Eleonora Lippolis
- Institute of Human Genetics, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Fulvia Ferrazzi
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
- Institute of Human Genetics, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Wolfgang Otto
- Caritas St. Josef Medical Center, Department of Urology, Regensburg University, 93053 Regensburg, Germany; (W.O.); (S.D.); (J.B.); (M.B.)
| | - Luitpold Distel
- Department of Radiation Therapy, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (L.D.); (R.F.)
| | - Rainer Fietkau
- Department of Radiation Therapy, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (L.D.); (R.F.)
| | - Stefan Denzinger
- Caritas St. Josef Medical Center, Department of Urology, Regensburg University, 93053 Regensburg, Germany; (W.O.); (S.D.); (J.B.); (M.B.)
| | - Johannes Breyer
- Caritas St. Josef Medical Center, Department of Urology, Regensburg University, 93053 Regensburg, Germany; (W.O.); (S.D.); (J.B.); (M.B.)
| | - Maximilian Burger
- Caritas St. Josef Medical Center, Department of Urology, Regensburg University, 93053 Regensburg, Germany; (W.O.); (S.D.); (J.B.); (M.B.)
| | - Simone Bertz
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
| | - Markus Eckstein
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
| | - Annette Ebner
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
| | - Arndt Hartmann
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
| | - Carol-I. Geppert
- Institute of Pathology, Friedrich-Alexander-University, Erlangen-Nürnberg, 91054 Erlangen, Germany; (S.H.); (F.F.); (S.B.); (M.E.); (A.E.); (A.H.)
- Correspondence: ; Tel.: +49-9131-85-43649
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