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Abstract：
BACKGROUND: Evidence suggests that radiotherapy is a potent immunomodulator in non-small cell lung cancer (NSCLC). Conversely, it has rarely been demonstrated if immune infiltration can influence radiotherapy efficacy. Herein, we explored the effect of tumor-infiltrating lymphocytes (TILs) on the response to postoperative radiotherapy (PORT) in completely resected stage III-pN2 NSCLC.
METHODS: This retrospective study included 244 patients with pathologically confirmed stage III-N2 NSCLC who underwent complete resection at our institution between 2014 and 2020. TILs were assessed with permanent full-face hematoxylin and eosin (H&E) sections and the evaluation of TILs was based on a published guideline. Patients were stratified into the TILlow or TILhigh group with a cutoff value of 50%. Kaplan-Meier method and Log-rank test were utilized to assess disease-free survival (DFS) and overall survival (OS). Univariate and multivariate Cox regression analysis were conducted to determine prognostic indicators.
RESULTS: Among 244 patients, a total of 121 patients received PORT whereas 123 did not. TILs level in patients with PORT was significantly higher than that in patients without PORT (p < 0.001). High TILs level was significantly associated with an improved DFS and OS in all the entire chort (DFS, p < 0.001; OS, p = 0.001), PORT chort (DFS, p = 0.003; OS, p = 0.011) and non-PORT chort (DFS, p < 0.001; OS, p = 0.034). There were no significant survival differences between different treatment modalities in the low TILs infiltration (DFS, p = 0.244; OS, p = 0.404) and high TILs infiltration (DFS, p = 0.167; OS, p = 0.958) groups.
CONCLUSIONS: TILs evaluated with H&E sections could represent a prognostic biomarker in patients with completely resected pN2 NSCLC, and high TILs infiltration was associated with favorable survival outcomes.The predictive value of TILs for PORT still need to be further explored in the future.
METHODS: This retrospective study included 244 patients with pathologically confirmed stage III-N2 NSCLC who underwent complete resection at our institution between 2014 and 2020. TILs were assessed with permanent full-face hematoxylin and eosin (H&E) sections and the evaluation of TILs was based on a published guideline. Patients were stratified into the TILlow or TILhigh group with a cutoff value of 50%. Kaplan-Meier method and Log-rank test were utilized to assess disease-free survival (DFS) and overall survival (OS). Univariate and multivariate Cox regression analysis were conducted to determine prognostic indicators.
RESULTS: Among 244 patients, a total of 121 patients received PORT whereas 123 did not. TILs level in patients with PORT was significantly higher than that in patients without PORT (p < 0.001). High TILs level was significantly associated with an improved DFS and OS in all the entire chort (DFS, p < 0.001; OS, p = 0.001), PORT chort (DFS, p = 0.003; OS, p = 0.011) and non-PORT chort (DFS, p < 0.001; OS, p = 0.034). There were no significant survival differences between different treatment modalities in the low TILs infiltration (DFS, p = 0.244; OS, p = 0.404) and high TILs infiltration (DFS, p = 0.167; OS, p = 0.958) groups.
CONCLUSIONS: TILs evaluated with H&E sections could represent a prognostic biomarker in patients with completely resected pN2 NSCLC, and high TILs infiltration was associated with favorable survival outcomes.The predictive value of TILs for PORT still need to be further explored in the future.
摘要：
背景：证据表明放疗是非小细胞肺癌（NSCLC）的有效免疫调节剂。相反，很少有证据表明免疫浸润是否会影响放疗疗效。在这里，我们探讨了肿瘤浸润淋巴细胞(TIL)对完全切除的III-pN2期NSCLC术后放疗(PORT)反应的影响.
方法：这项回顾性研究纳入了244例经病理证实的III-N2期非小细胞肺癌患者，他们在2014年至2020年间在我们机构接受了完全切除。使用永久性全脸苏木精和曙红（H＆E）切片评估TIL，TIL的评估基于已发布的指南。将患者分层为TILlow或TILhigh组，截止值为50％。使用Kaplan-Meier方法和Log-rank检验评估无病生存期(DFS)和总生存期(OS)。进行单因素和多因素Cox回归分析以确定预后指标。
结果：在244名患者中，共有121例患者接受了PORT,而123例未接受.PORT患者的TILs水平明显高于无PORT患者（p<0.001）。在整个过程中，高TIL水平与改进的DFS和操作系统显着相关(DFS，p<0.001；OS，p=0.001),港口港口(DFS,p=0.003;OS,p=0.011)和非港口港口港口(DFS，p<0.001；OS，p=0.034)。在低TILs浸润的不同治疗方式之间没有显著的生存差异(DFS，p=0.244;OS,p=0.404)和高TIL渗透(DFS，p=0.167;OS,p=0.958)组。
结论：用H&E切片评估的TILs可以代表完全切除pN2NSCLC患者的预后生物标志物，高TILs浸润与良好的生存结局相关。未来TILs对PORT的预测价值仍需进一步探讨。
方法：这项回顾性研究纳入了244例经病理证实的III-N2期非小细胞肺癌患者，他们在2014年至2020年间在我们机构接受了完全切除。使用永久性全脸苏木精和曙红（H＆E）切片评估TIL，TIL的评估基于已发布的指南。将患者分层为TILlow或TILhigh组，截止值为50％。使用Kaplan-Meier方法和Log-rank检验评估无病生存期(DFS)和总生存期(OS)。进行单因素和多因素Cox回归分析以确定预后指标。
结果：在244名患者中，共有121例患者接受了PORT,而123例未接受.PORT患者的TILs水平明显高于无PORT患者（p<0.001）。在整个过程中，高TIL水平与改进的DFS和操作系统显着相关(DFS，p<0.001；OS，p=0.001),港口港口(DFS,p=0.003;OS,p=0.011)和非港口港口港口(DFS，p<0.001；OS，p=0.034)。在低TILs浸润的不同治疗方式之间没有显著的生存差异(DFS，p=0.244;OS,p=0.404)和高TIL渗透(DFS，p=0.167;OS,p=0.958)组。
结论：用H&E切片评估的TILs可以代表完全切除pN2NSCLC患者的预后生物标志物，高TILs浸润与良好的生存结局相关。未来TILs对PORT的预测价值仍需进一步探讨。
