Concurrently, increased TLS density in the IM region was associated with squamous cell carcinoma (P=0.005), lymph node metastasis (P=0.013), and smoking history (P=0.045), while higher PT TLS density was mainly in male patients (P=0.001), associated with squamous cell carcinoma (P=0.000), large tumor diameter (P=0.013), smoking history (P=0.004), and absence of P53 (P=0.015), which may indicate that TLS density in the IM and PT regions was associated with adverse factors like tumor growth, invasion, and metastasis. This evidence concerns the gene TP53 and metastatic malignant neoplasm in the lymph nodes.