Prognostic significance of tumor-infiltrating lymphocytes in predicting outcome of distal cholangiocarcinoma in Thailand

Piyapharom Intarawichian; Sirada Sangpaibool; Piya Prajumwongs; Prakasit Sa-Ngiamwibool; Sakkarn Sangkhamanon; Waritta Kunprom; Malinee Thanee; Watcharin Loilome; Narong Khuntikeo; Attapol Titapun; Apiwat Jareanrat; Vasin Thanasukarn; Tharatip Srisuk; Vor Luvira; Kulyada Eurboonyanun; Julaluck Promsorn; Supinda Koonmee; Aileen Wee; Chaiwat Aphivatanasiri

doi:10.3389/fonc.2022.1004220

Prognostic significance of tumor-infiltrating lymphocytes in predicting outcome of distal cholangiocarcinoma in Thailand

Front Oncol. 2022 Dec 13:12:1004220. doi: 10.3389/fonc.2022.1004220. eCollection 2022.

Authors

Piyapharom Intarawichian^{1

2

3}, Sirada Sangpaibool^{1

2

3}, Piya Prajumwongs^{1

2

3}, Prakasit Sa-Ngiamwibool^{1

2

3}, Sakkarn Sangkhamanon^{1

2

3}, Waritta Kunprom^{1

2

3}, Malinee Thanee^{1

2

3}, Watcharin Loilome^{1

2

4}, Narong Khuntikeo^{1

2

5}, Attapol Titapun^{1

2

5}, Apiwat Jareanrat^{1

2

5}, Vasin Thanasukarn^{1

2

5}, Tharatip Srisuk^{1

2

5}, Vor Luvira^{1

2

5}, Kulyada Eurboonyanun^{1

2

6}, Julaluck Promsorn^{1

2

6}, Supinda Koonmee^{1

2

3}, Aileen Wee⁷, Chaiwat Aphivatanasiri^{1

2

3}

Affiliations

¹ Cholangiocarcinoma Screening and Care Program (CASCAP), Khon Kaen University, Khon Kaen, Thailand.
² Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand.
³ Department of Pathology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁴ Department of Biochemistry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁵ Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁶ Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
⁷ Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore.

Abstract

Patients with distal cholangiocarcinoma (dCCA) generally have poor outcomes because of late presentation and diagnosis. Therefore, prognostic factors for predicting outcomes are essential to improve therapeutic strategies and quality of life. Tumor-infiltrating lymphocytes (TILs) have been reported as a prognostic predictor in several cancers. However, their role in dCCA is still unclear. This study aimed to evaluate the association of TILs with outcome in patients with dCCA. Fifty-two patients were evaluated for the percentage rate of TILs in their cancers, and a median TIL level was used to divide the patients into two groups. Survival, multivariate, and correlation analyses were performed to determine the prognostic factors. Results showed that a low TIL level was associated with poor survival. Multivariate analysis revealed TILs as an independent factor for poor outcome. Moreover, TILs were markedly correlated with growth patterns, and both were applied to classify patients with dCCA. Subgroups of TILs with growth pattern incorporation improved stratification performance in separating good from poor patient outcomes. This study suggested that TILs could be a prognostic factor for predicting survival and for clustering patients with dCCA to improve prognostication capability. This finding may be incorporated into a new staging system for stratifying dCCA in Thailand.

Keywords: distal cholangiocarcinoma; growth pattern; predicting outcome; prognosis; tumor-infiltrating lymphocytes (TILs).

Copyright © 2022 Intarawichian, Sangpaibool, Prajumwongs, Sa-Ngiamwibool, Sangkhamanon, Kunprom, Thanee, Loilome, Khuntikeo, Titapun, Jareanrat, Thanasukarn, Srisuk, Luvira, Eurboonyanun, Promsorn, Koonmee, Wee and Aphivatanasiri.