Abstract
BACKGROUND: Tertiary lymphoid structures (TLSs) correlate with improved survival in various cancers, but their prognostic significance and imaging correlations in glioblastoma (GBM) remain unclear. This study investigated the relationship between TLSs, survival outcomes, and imaging features in GBM patients. METHODS: A retrospective analysis of 190 newly diagnosed GBM patients was conducted. TLSs were identified via hematoxylin-eosin staining, with maturity assessed by multiplex immunofluorescence (CD20/CD3/CD21/CD23) into mature (mTLSs) and immature (imTLSs) subgroups. Survival analysis used Kaplan-Meier method, and TLS predictive models were developed via logistic regression. Clinicopathological and VASARI imaging features were compared. RESULTS: Of 190 cases, 85 (44.73%) were TLSs+, comprising 47 imTLSs and 38 mTLSs. Mean overall survival (OS) was 11.82 months. Significant OS differences were observed between TLSs+ (14.67 months) and TLSs- (9.51 months) groups, and between mTLSs (19.36 months) and imTLSs (10.87 months) groups (all P < .05). VASARI features f2, f8, f17, and f22 differed significantly between TLSs+/TLSs- groups, while f6, f16, and f18 differed between mTLSs/imTLSs groups (all P < .05). These features were independent predictors of TLS presence and maturity. CONCLUSION: TLSs exist at varying maturation stages in GBM and represent favorable prognostic biomarkers. Their presence and maturity significantly correlate with OS and specific VASARI features. Preoperative imaging prediction of TLSs may facilitate risk stratification and individualized treatment for GBM patients.