Department of Breast Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China.
Department of Pathology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 610000, China.
Breast Cancer Res Treat. 2021 Feb;185(3):629-638. doi: 10.1007/s10549-020-06015-4. Epub 2020 Nov 9.
The present study evaluated tumor-infiltrating lymphocytes (TILs) based on standardized scoring method and investigated its predictive value for axillary pathologic complete response (apCR) and prognostic significance for event-free survival (EFS) in neoadjuvant-treated HER2-positive breast cancer with initially biopsy-proven nodal metastasis.
We assessed TILs in a total of 187 pretherapeutic core biopsies of primary tumors. Receiver operating characteristic curve analysis was conducted to calculate the optimal cut-off point of TILs in discriminating axillary pathologic response. The associations of TILs with apCR or EFS were investigated by univariate and multivariate analyses.
Receiver operating characteristic curve analysis identified a 10% cut-off point of TILs that optimally discriminated apCR from non-apCR (P < 0.001). High TILs were determined as TILs ≥ 10%, and tumor with TILs < 10% was defined as lymphocyte-depleted breast cancer (LDBC). The apCR rate of the entire cohort was 66.3% (124/187). Tumors with high TILs had a significantly higher apCR rate compared with LDBC (78.5% vs. 43.9%; P < 0.001). High TILs (P < 0.001), breast pathologic complete response (P = 0.006), and negative status of hormone receptor (P = 0.021) were independent predictors for apCR. High TILs were a markedly powerful predictor with an odds ratio of 4.01 (P < 0.001). EFS was significantly better among patients with high TILs than among those with LDBC (P < 0.001). Univariate and multivariate analyses indicated that high TILs (P = 0.019) and apCR (P = 0.013) were independent predictors for favorable EFS.
TILs have predictive value for apCR and prognostic significance for EFS in initially node-positive and HER2-positive breast cancer treated with neoadjuvant therapy. LDBC (TILs < 10%) has a significantly unfavorable impact on apCR rate and EFS.
本研究基于标准化评分方法评估肿瘤浸润淋巴细胞（TILs），并探讨其在经新辅助治疗的初始活检证实淋巴结转移的 HER2 阳性乳腺癌中预测腋窝病理完全缓解（apCR）和对无事件生存（EFS）的预后意义。
我们评估了总共 187 例原发性肿瘤的术前核心活检标本中的 TILs。采用受试者工作特征曲线分析计算 TILs 区分腋窝病理反应的最佳截断点。通过单因素和多因素分析研究 TILs 与 apCR 或 EFS 的关系。
受试者工作特征曲线分析确定了 10%的 TILs 截断点可最佳区分 apCR 与非 apCR（P<0.001）。高 TILs 定义为 TILs≥10%，TILs<10%的肿瘤定义为淋巴细胞耗竭性乳腺癌（LDBC）。整个队列的 apCR 率为 66.3%（124/187）。高 TILs 组的 apCR 率明显高于 LDBC 组（78.5%比 43.9%；P<0.001）。高 TILs（P<0.001）、乳腺病理完全缓解（P=0.006）和激素受体阴性（P=0.021）是 apCR 的独立预测因素。高 TILs 是一个显著强大的预测因子，优势比为 4.01（P<0.001）。高 TILs 组的 EFS 明显优于 LDBC 组（P<0.001）。单因素和多因素分析表明，高 TILs（P=0.019）和 apCR（P=0.013）是 EFS 良好的独立预测因素。
TILs 对经新辅助治疗的初始淋巴结阳性和 HER2 阳性乳腺癌的 apCR 具有预测价值，对 EFS 具有预后意义。LDBC（TILs<10%）对 apCR 率和 EFS 有明显不利影响。
