Song Xinming, Ma Jianli, Zhang Han, Zhang Qingyuan
Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China.
Department of Radiation Oncology, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, China.
Gland Surg. 2020 Oct;9(5):1450-1468. doi: 10.21037/gs-20-622.
The ability to predict high risk factors for recurrence after neoadjuvant chemotherapy (NAC) is controversial. The purpose of the present study was to investigate the prognostic significance of tumor location, tumor-infiltrating lymphocyte (TIL) level, and pretreatment lymphocyte-to-monocyte ratio (LMR) in determining the survival of patients with estrogen receptor (ER)-positive, human epidermal growth factor receptor-2 (HER2)-negative breast cancer after treatment with NAC.
The clinical data of 285 ER-positive, HER2-negative patients with clinical stage II-III breast cancer were analyzed from January 2009 to January 2015. To explore the prognostic factors for ER-positive, HER2-negative patients, we combined the conventional clinicopathological prognostic factors with tumor location, pretreatment LMR, and TIL. In addition, samples from 79 patients, who did not achieve pathological complete response (pCR) testing after NAC, were selected for hematoxylin-eosin (HE) staining to analyze the effect of TIL on prognosis.
An LMR >5.2 was correlated with better 5-year disease-free survival (DFS) and overall survival (OS; P<0.001 and P<0.001, respectively). Patients with lower-inner/central quadrant tumors had lower 5-year DFS and OS than patients with tumors in the other quadrants (P=0.012 and P=0.048). Patients with a lower TIL level (≤10%) had better 5-year DFS than patients with a higher TIL level (P=0.010). According to the results of the multivariate analyses, tumor location was an independent prognostic factor for 5-year DFS (P=0.021). Pretreatment LMR was associated with both 5-year DFS and OS (P<0.001 and P<0.001, respectively). In the subgroup analysis stratified by TIL level, the TIL level and the initial clinical stage were associated with 5-year DFS (P=0.027 and P<0.001, respectively).
We explored the prognostic significance of the tumor site, TIL level, and pretreatment LMR level for ER-positive, HER2-negative patients. We concluded that the lower-inner/central quadrant tumors, TIL >10%, and pretreatment LMR level ≤5.2 were correlated with a poor prognosis. More aggressive NAC and/or endocrine therapy with internal mammary node radiotherapy (IMN-RT) should be administered to address the relatively poor prognosis of patients with breast carcinoma presenting the aforementioned adverse factors.
新辅助化疗（NAC）后预测复发高危因素的能力存在争议。本研究的目的是探讨肿瘤位置、肿瘤浸润淋巴细胞（TIL）水平和治疗前淋巴细胞与单核细胞比值（LMR）在确定雌激素受体（ER）阳性、人表皮生长因子受体2（HER2）阴性乳腺癌患者接受NAC治疗后的生存情况方面的预后意义。
分析2009年1月至2015年1月期间285例临床II-III期ER阳性、HER2阴性乳腺癌患者的临床资料。为了探索ER阳性、HER2阴性患者的预后因素，我们将传统的临床病理预后因素与肿瘤位置、治疗前LMR和TIL相结合。此外，选取79例NAC后未达到病理完全缓解（pCR）检测的患者的样本进行苏木精-伊红（HE）染色，以分析TIL对预后的影响。
LMR>5.2与更好的5年无病生存期（DFS）和总生存期（OS）相关（分别为P<0.001和P<0.001）。内下/中央象限肿瘤患者的5年DFS和OS低于其他象限肿瘤患者（P=0.012和P=0.048）。TIL水平较低（≤10%）的患者5年DFS优于TIL水平较高的患者（P=0.010）。根据多因素分析结果，肿瘤位置是5年DFS的独立预后因素（P=0.021）。治疗前LMR与5年DFS和OS均相关（分别为P<0.001和P<0.001）。在按TIL水平分层的亚组分析中，TIL水平和初始临床分期与5年DFS相关（分别为P=0.027和P<0.001）。
我们探讨了肿瘤部位、TIL水平和治疗前LMR水平对ER阳性、HER2阴性患者的预后意义。我们得出结论，内下/中央象限肿瘤、TIL>10%和治疗前LMR水平≤5.2与预后不良相关。对于具有上述不利因素的乳腺癌患者，应给予更积极的NAC和/或内分泌治疗联合内乳淋巴结放疗（IMN-RT），以改善其相对较差的预后。
