Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
Department of Diagnostic Pathology, Nara Medical University, Nara, Japan.
Surg Today. 2021 Apr;51(4):595-604. doi: 10.1007/s00595-020-02157-6. Epub 2020 Oct 14.
We investigated the role of tumor-infiltrating lymphocytes (TILs) in pretreatment primary breast cancer to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with clinical node-positive disease (cN +).
The subjects of this study were 60 patients with cN + , who received NAC followed by breast surgery with axillary lymph node dissection (ALND). We conducted a semi-quantitative assessment of TILs in pretreatment primary tumors and their association with clinicopathological factors and axillary lymph node metastasis.
We observed a higher number of TILs in tumors with negative hormone receptors, positive human epidermal growth factor receptor 2, or high Ki67. TILs were associated with a favorable response to NAC in primary tumors. The rate of axillary pathologic complete response (Ax-pCR) was significantly higher in patients with a high number of TILs than in patients with a low number of TILs (72.0% versus 17.1%, p < 0.001). In multivariable analysis, a high number of TILs was a significant predictor of Ax-pCR as well as of pCR of the primary tumor after NAC. Importantly, all patients with HER2-positive tumors in the high TILs group showed Ax-pCR on ALND.
TILs in pretreatment primary breast cancer had the potential to predict therapeutic efficacy of NAC in patients with clinical node-positive disease.
本研究旨在探讨肿瘤浸润淋巴细胞（TILs）在原发性乳腺癌新辅助化疗（NAC）前的作用，以预测临床淋巴结阳性（cN+）患者对 NAC 的病理反应。
本研究纳入了 60 例接受 NAC 联合腋窝淋巴结清扫术（ALND）的 cN+患者。我们对原发性肿瘤的 TILs 进行了半定量评估，并分析了其与临床病理因素和腋窝淋巴结转移的关系。
我们观察到，TILs 在激素受体阴性、人表皮生长因子受体 2 阳性或 Ki67 高的肿瘤中数量较多。TILs 与原发性肿瘤对 NAC 的良好反应相关。高 TILs 组的腋窝病理完全缓解（Ax-pCR）率明显高于低 TILs 组（72.0% vs. 17.1%，p<0.001）。多变量分析显示，高 TILs 是 Ax-pCR 以及 NAC 后原发性肿瘤 pCR 的显著预测因子。重要的是，高 TILs 组所有 HER2 阳性肿瘤患者在 ALND 时均显示 Ax-pCR。
原发性乳腺癌中 TILs 具有预测临床淋巴结阳性患者 NAC 疗效的潜力。
