Dvision of Breast and Endocrine Surgery, Graduate School of Medicine, Gunma University, Gunma, Japan.
Department of General Surgical Science, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
Breast Cancer Res Treat. 2020 Jun;181(2):331-338. doi: 10.1007/s10549-020-05619-0. Epub 2020 Apr 6.
High F18-fluorodeoxyglucose (FDG) uptake has been reported to be a predictor of poor prognosis in patients with breast cancer. We investigated the relationship between FDG uptake and immunological factors, including the data of programmed cell death-ligand 1 (PD-L1), CD8, and tumor-infiltrating lymphocytes (TILs).
Breast cancer tissues of 97 patients who underwent surgery without preoperative therapy were examined. The grade of stromal TILs was immunohistochemically evaluated using the criteria of the International TILs Working Group in breast cancer. PD-L1 positivity and CD8 positivity were immunohistochemically evaluated. The FDG uptakes were evaluated based on the standardized uptake value max (SUVmax). The relationships between SUVmax and TIL grade and expression of PD-L1 and CD8 were investigated.
Among the 97 patients, 41 (42.3%) had a high SUVmax in their primary tumor, based on the SUVmax cut-off value 3 yielded by receiver operating characteristic curves. PD-L1 was positive in 17 patients (17.5%). Our analyses revealed that large tumor size, high nuclear grade, high degree of TILs and positive expression of PD-L1 were significantly associated with high SUVmax in the primary tumor. There were significant associations between SUVmax and the degree of TILs (r = 0.428, p < 0.001) and between SUVmax and the PD-L1 positivity (r = 0.413, p < 0.001). All cases with a high degree of TILs showed high CD8 expression.
Our results indicate that the FDG uptake may be predictive of immunological features including TILs and PD-L1 expression in breast cancer patients. Additional research is necessary to further evaluate FDG-PET as a biomarker of immune checkpoint therapy in breast cancer.
高 F18-氟代脱氧葡萄糖（FDG）摄取已被报道可预测乳腺癌患者的预后不良。我们研究了 FDG 摄取与免疫因素之间的关系，包括程序性细胞死亡配体 1（PD-L1）、CD8 和肿瘤浸润淋巴细胞（TIL）的数据。
对 97 例未经术前治疗而行手术的乳腺癌患者的组织进行了检查。使用国际 TIL 工作组在乳腺癌中的标准，通过免疫组织化学评估间质 TIL 分级。通过免疫组织化学评估 PD-L1 阳性和 CD8 阳性。基于标准化摄取值最大值（SUVmax）评估 FDG 摄取。研究了 SUVmax 与 TIL 分级以及 PD-L1 和 CD8 表达之间的关系。
在 97 例患者中，根据接受者操作特征曲线得出的 SUVmax 截断值 3，有 41 例（42.3%）原发肿瘤 SUVmax 较高。17 例（17.5%）患者 PD-L1 阳性。我们的分析表明，肿瘤较大、核分级较高、TIL 程度较高和 PD-L1 阳性表达与原发肿瘤 SUVmax 较高显著相关。SUVmax 与 TIL 程度之间存在显著相关性（r=0.428，p<0.001），SUVmax 与 PD-L1 阳性之间也存在显著相关性（r=0.413，p<0.001）。所有 TIL 程度较高的病例均表现出高 CD8 表达。
我们的结果表明，FDG 摄取可能可预测乳腺癌患者的免疫特征，包括 TIL 和 PD-L1 表达。需要进一步研究以进一步评估 FDG-PET 作为乳腺癌免疫检查点治疗的生物标志物。
