Survival benefit and spatial properties of tertiary lymphoid structures in esophageal squamous cell carcinoma with neoadjuvant therapies

TLSs were observed in 359 esophageal squamous cell carcinoma patients receiving various neoadjuvant therapies.

• Mature TLS (MTLS) was identified as an independent prognostic factor in esophageal squamous cell carcinoma.
• The neoadjuvant immunotherapy group had the lowest cases of immature TLS, while the neoadjuvant chemoradiotherapy group had the lowest MTLSs.
• MTLSs were primarily found in stromal and normal compartments and were positively correlated with the outcomes of neoadjuvant therapy.
• The neoadjuvant immunotherapy group exhibited the highest density of T cells within 150 μm of TLSs compared to other groups.
• B cells were concentrated within TLSs, while T cells were mostly dispersed beyond 150 μm from TLSs.
• The novel PD-L1 combined positive score was positively associated with MTLSs and the efficacy of neoadjuvant therapies.

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