乳腺癌患者接受艾日布林化疗与肿瘤微环境中癌症进展类型的研究。
Study on the progression types of cancer in patients with breast cancer undergoing eribulin chemotherapy and tumor microenvironment.
机构信息
Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Department of Pharmacology, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
出版信息
J Transl Med. 2018 Mar 9;16(1):54. doi: 10.1186/s12967-018-1443-5.
BACKGROUND
Recently, the concepts of progression due to pre-existing lesions (PPL) and progression due to new metastasis (PNM) have been proposed to differentiate the progression types of treatment-resistant cancers. Previously, the differences between these two progression types did not affect the determination of treatment strategies since both PPL and PNM are classified as progressive disease based on the response evaluation criteria in solid tumors (RECIST) diagnostic criteria. On the other hand, tumor infiltrating lymphocytes (TILs) are effective when used as indicators for monitoring the immune tumor microenvironment (iTME) in the cancer host, and TILs play an important role as biomarkers in predicting prognosis and therapeutic effects. This study focused on the progression types of cancer in patients undergoing eribulin chemotherapy. In addition, the iTME in individuals with PPL and PNM was evaluated using TILs as a marker.
METHODS
Of the 52 patients with locally advanced or metastatic breast cancer who underwent chemotherapy with eribulin, 40 remained in the study, and 12 patients were dropout cases. The antitumor effect was evaluated based on the RECIST criteria using version 1.1. TILs were defined as the infiltrating lymphocytes within tumor stroma and were expressed in proportion to the field investigated. In PPL cases, the high-TIL group was considered as type I and the low-TIL group was classified as type II. In PNM cases, the high-TIL group was considered as type III and the low-TIL group was classified as type IV.
RESULTS
In 19 cases, individuals with type I progression had significantly longer progression free survival and overall survival (OS) compared to those with type III progression (p = 0.040, p < 0.001, log-rank). Individuals with type I progression had significantly prolonged survival post progression compared to those with type II progression (p = 0.048, log-rank). A multivariate analysis that validate the effect of OS showed that these were independent factors of good prognosis (p = 0.003; hazard ratio [HR] = 0.065) (p = 0.006; HR = 0.105).
CONCLUSIONS
The effects of eribulin chemotherapy suggested that patients with progressive-type breast cancer that proliferates in a good iTME may have a good prognosis.
背景
最近，提出了基于先前存在的病变的进展（PPL）和基于新转移的进展（PNM）的概念，以区分治疗耐药性癌症的进展类型。以前，这两种进展类型之间的差异并不影响治疗策略的确定，因为根据实体瘤反应评估标准（RECIST）诊断标准，PPL 和 PNM 均被归类为进展性疾病。另一方面，肿瘤浸润淋巴细胞（TIL）作为监测癌症宿主中免疫肿瘤微环境（iTME）的指标是有效的，并且 TIL 作为预测预后和治疗效果的生物标志物发挥着重要作用。本研究集中于接受艾日布林化疗的患者的癌症进展类型。此外，使用 TIL 作为标志物评估 PPL 和 PNM 个体的 iTME。
方法
在接受艾日布林化疗的 52 名局部晚期或转移性乳腺癌患者中，有 40 名仍在研究中，有 12 名患者脱落。使用版本 1.1 的 RECIST 标准评估抗肿瘤作用。TIL 被定义为肿瘤基质内浸润的淋巴细胞，并以调查区域表示。在 PPL 病例中，高 TIL 组被认为是 I 型，低 TIL 组被分类为 II 型。在 PNM 病例中，高 TIL 组被认为是 III 型，低 TIL 组被分类为 IV 型。
结果
在 19 例患者中，I 型进展的患者无进展生存期和总生存期（OS）明显长于 III 型进展的患者（p=0.040，p<0.001，对数秩）。与 II 型进展相比，I 型进展患者的进展后生存时间明显延长（p=0.048，对数秩）。验证 OS 效果的多变量分析表明，这些是良好预后的独立因素（p=0.003；风险比[HR]=0.065）（p=0.006；HR=0.105）。
结论
艾日布林化疗的效果表明，在良好的 iTME 中增殖的进展型乳腺癌患者可能具有良好的预后。
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