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Poster Display session 2

2876 - Multispectral analysis of lymphocyte complexity in periampullary adenocarcinoma


29 Sep 2019


Poster Display session 2


Tumour Site

Hepatobiliary Cancers


Sebastian Lundgren


Annals of Oncology (2019) 30 (suppl_5): v253-v324. 10.1093/annonc/mdz247


S. Lundgren1, J. Elebro1, M. Heby1, B. Nodin1, K. Leandersson2, P. Micke3, K. Jirström1, A. Mezheyeuski3

Author affiliations

  • 1 Department Of Clinical Sciences Lund, Oncology And Pathology, Lund University, Lund, Sweden, Lund University, 221 85 - Lund/SE
  • 2 Cancer Immunology, Department Of Translational Medicine, Lund University, Malmö, Sweden, Lund University, 221 85 - Lund/SE
  • 3 Department Of Immunology, Genetics And Pathology, Uppsala University, 751 85 - Uppsala/SE


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Abstract 2876


Periampullary adenocarcinomas are a heterogenous group of tumours. Tumour morphology, i.e. intestinal type (I-type) and pancreatobiliary type (PB-type), is a more relevant prognostic factor than anatomical origin. Despite the promising effects of cancer immunotherapy, phase I and II clinical trials have this far been disappointing in pancreas cancer. The aim of this study was to map the spatial distribution of lymphocyte subsets in the tumour microenvironment of periampullary adenocarcinoma, in relation to overall survival (OS) and morphology.


Multiplexed immunohistochemistry was performed on tissue microarrays with tumours from a well characterized consecutive cohort of 175 patients with resected periampullary adenocarcinoma. A panel of immune cell markers including CD4, CD8a, FoxP3, CD20, CD45RO and pan-cytokeratin was applied.


There was no difference in infiltration levels of different lymphocyte populations when taking into account both stromal and tumour compartments, however, in the latter, there were significantly higher levels of activated CD4+ cells (p = 0.027) in PB-type tumors while activated CD8+ cells (p < 0.001), CD8+ Tregs (p = 0.001) FoxP3+CD45ROhigh cells (p = 0.026) and B-cells (p = 0.011) were significantly higher in I-type tumours. In the stromal compartment, FoxP3+CD45ROhigh cells were significantly higher in I-type tumors (p = 0.004). Several immune signatures were defined, and, notably, signatures with low overall lymphocyte infiltration had a significantly worse OS. Composition of immune signatures and their impact on OS differed depending on the tissue compartment. In the stromal compartment, a signature characterized by high levels of activated CD4+ and CD8+ cells, B-cells, FoxP3+CD45ROhigh cells and low levels of FoxP3+CD45ROlow cells fared significantly better than 6 of 7 defined signatures (p = 0.045, p = 0.006, p = 0.019, p < 0.001 and, p = 0.047, respectively).


These data demonstrate that the composition and clinical impact of immune infiltrates in periampullary adenocarcinoma differ by morphological type as well as localisation. Hence, all these factors should be considered in studies on their prognostic and predictive ability.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Lund University.


Mrs Berta Kamprad Foundation, Skåne University Hospital Research Foundation, Lund University Medical Faculty Research grants.


All authors have declared no conflicts of interest.

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