West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China.
Department of Breast Surgery, West China Hospital, Sichuan University, Chengdu, China.
J Surg Oncol. 2021 Jan;123(1):89-95. doi: 10.1002/jso.26252. Epub 2020 Oct 12.
Tumor-infiltrating lymphocytes (TILs) are predictive for the response to neoadjuvant chemotherapy (NAC) of breast cancer. However, little is known about the predictive value of TILs for axillary lymph node involvement after NAC.
We analyzed 282 breast cancer patients who were operated following NAC and curative surgery from 2008 to 2018. TILs were assessed in core needle biopsies before NAC, and the biopsies were divided into three groups: low (0%-10% immune cells in stromal tissue within the tumor), intermediate (11%-59%), and high (≥60%). The patients were followed for an average of 63 months (range, 2-116 months). We analyzed retrospectively the predictive value of TILs for the response to NAC, including pathological complete response (pCR) and axillary lymph node involvement (positive lymph node ratio (LNR; the ratio of the number of nodes involved to the total number of nodes dissected)). The prognostic values of TILs and LNR were assessed.
A pCR was achieved in 27 of 188 patients (14.4%) in the low-TIL group, in 14 of 57 patients (24.6%) in the intermediate-TIL group, and in 13 of 37 (35.1%) in the high-TIL group (p = .007). Among patients who underwent axillary lymph node dissection after NAC, patients with high TILs had lower LNR (p = 0021) compared with the other groups. Kaplan-Meier analysis showed that overall survival (OS; p < .001) and disease-free survival (p < .001) were significantly longer for patients with low LNR (≤0.2). TILs were positively correlated with disease-free survival (p = .028), but TILs did not correlate with OS (p = .171). Moreover, by multivariable analysis, LNR independently affected disease-free survival (p < .001).
TILs may be predictive for pCR rate, postoperative residual lymph node involvement, and disease-free survival of breast cancer patients. High TILs may suggest favorable outcomes.
肿瘤浸润淋巴细胞（TILs）可预测乳腺癌新辅助化疗（NAC）的反应。然而，对于 NAC 后腋窝淋巴结受累的 TILs 预测价值知之甚少。
我们分析了 2008 年至 2018 年间接受 NAC 和根治性手术的 282 例乳腺癌患者。在 NAC 前的核心针活检中评估 TILs，并将活检分为三组：低（肿瘤间质组织中免疫细胞为 0%-10%）、中（11%-59%）和高（≥60%）。患者平均随访 63 个月（范围 2-116 个月）。我们回顾性分析了 TILs 对 NAC 反应的预测价值，包括病理完全缓解（pCR）和腋窝淋巴结受累（阳性淋巴结比（LNR；受累淋巴结数与淋巴结总数之比））。评估了 TILs 和 LNR 的预后价值。
低 TIL 组 188 例患者中有 27 例（14.4%）达到 pCR，中 TIL 组 57 例患者中有 14 例（24.6%）达到 pCR，高 TIL 组 37 例患者中有 13 例（35.1%）达到 pCR（p=0.007）。在接受 NAC 后行腋窝淋巴结清扫的患者中，高 TIL 组的 LNR 较低（p=0.021）。Kaplan-Meier 分析显示，低 LNR（≤0.2）患者的总生存期（OS；p<0.001）和无病生存期（DFS；p<0.001）明显更长。TILs 与无病生存期呈正相关（p=0.028），但与 OS 无关（p=0.171）。此外，多变量分析显示，LNR 独立影响无病生存期（p<0.001）。
TILs 可能预测乳腺癌患者的 pCR 率、术后残留淋巴结受累和无病生存率。高 TILs 可能提示预后良好。
