Xu Fei-Fei, Zheng Sai-Fang, Xu Cheng, Cai Gang, Wang Shu-Bei, Qi Wei-Xiang, Wang Chao-Fu, Chen Jia-Yi, Lu Cao
Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
Oncoimmunology. 2021 Mar 18;10(1):1875637. doi: 10.1080/2162402X.2021.1875637.
This study aims to identify the density of TILs in ductal carcinoma in situ (DCIS) in terms of prognostic significance with recurrence and the benefit of whole breast irradiation (WBI). The clinicopathological data of DCIS patients from Jan 2009 to Dec 2016 who received breast-conserving surgery (BCS) were retrospectively reviewed. Cox regression analysis was used to confirm independent prognostic factors of ipsilateral breast tumor recurrence (IBTR). Kaplan-Meier method was utilized to analyze IBTR and values of WBI. Touching-tumor-infiltrating lymphocytes (TILs) were defined by TILs touching or within one lymphocyte cell thickness from the malignant ducts' basement membrane. In total, 129 patients were enrolled in this analysis with 98 patients who received WBI. After a median follow-up of 53.0 months, there were 16 IBTR events with five invasive IBTRs. Univariate and multivariate analyses showed that touching-TILs >5 were an independent prognostic factor for higher IBTR (HR = 6.17, 95%CI 1.95-19.56, < .01). The whole cohort was classified into two subgroups: dense group (>5 touching-TILs per duct) and sparse group (≤5 touching-TILs per duct). Dense touching-TILs were associated with unfavorable biologic characteristics. The 5-y rate of IBTR between dense and sparse group was 29.0% versus 4.5% ( < .01). For the sparse group, WBI significantly reduced the rate of 5-y-IBTR risk from 13.2% to 1.7% ( = .02), but there was no benefit of WBI in the dense group. Touching-TILs density was heterogeneous in patients with DCIS. Sparse touching-TILs were associated with better prognosis and benefit from WBI. Dense touching-TILs not only were associated with a higher risk of IBTR but also lack of benefit from WBI.
本研究旨在确定导管原位癌（DCIS）中肿瘤浸润淋巴细胞（TILs）的密度对于复发的预后意义以及全乳照射（WBI）的益处。回顾性分析了2009年1月至2016年12月期间接受保乳手术（BCS）的DCIS患者的临床病理资料。采用Cox回归分析确定同侧乳腺肿瘤复发（IBTR）的独立预后因素。利用Kaplan-Meier法分析IBTR和WBI的价值。接触肿瘤浸润淋巴细胞（TILs）定义为TILs接触或距恶性导管基底膜一个淋巴细胞厚度范围内。本分析共纳入129例患者，其中98例接受了WBI。中位随访53.0个月后，发生16例IBTR事件，其中5例为浸润性IBTR。单因素和多因素分析显示，接触TILs>5是IBTR升高的独立预后因素（HR = 6.17，95%CI 1.95 - 19.56，P <.01）。整个队列分为两个亚组：密集组（每个导管>5个接触TILs）和稀疏组（每个导管≤5个接触TILs）。密集的接触TILs与不良生物学特征相关。密集组和稀疏组的5年IBTR率分别为29.0%和4.5%（P <.01）。对于稀疏组，WBI显著降低了5年IBTR风险率，从13.2%降至1.7%（P =.02），但在密集组中WBI没有益处。DCIS患者的接触TILs密度存在异质性。稀疏的接触TILs与较好的预后相关且受益于WBI。密集的接触TILs不仅与较高的IBTR风险相关，而且未从WBI中获益。
