肿瘤浸润淋巴细胞比例与乳腺癌临床病理特征和预后的关系

Relationship between tumor infiltrating lymphocytes and clinicopathological features and prognosis in patients with breast cancer

目的:观察乳腺癌组织中肿瘤浸润淋巴细胞(TILs)比例的情况,并探讨TILs比例与乳腺癌临床病理特征及预后的关系。方法:收集2015年1月1日至2017年1月1日于山东大学齐鲁医院(青岛)诊断为乳腺浸润性导管癌并行乳腺癌根治术的女性患者的临床资料。计算手术切除肿瘤组织标本中TILs比例,分为高比例(TILs≥50%)和低比例(TILs<50%),分析其与乳腺癌临床病理特征和预后的关系。结果:(1)激素受体阴性的患者中TILs高比例数量高于阳性患者(均P=0.000);Her2阳性患者的TILs高比例数量高于Her2阴性的患者(P=0.002);非Luminal型乳腺癌(Her2过表达和三阴性乳腺癌)的TILs高比例数量高于Luminal型乳腺癌(P=0.000)。(2)对于非Luminal型乳腺癌,Kaplan-Meier单因素分析结果显示,TILs比例(P=0.035)和淋巴结状态(P=0.000)与无进展生存期(DFS)有关;多因素Cox回归分析结果显示,淋巴结转移为非Luminal型乳腺癌患者DFS的独立危险因素(HR=2.021,95%CI:1.059~3.856,P=0.033),而TILs高比例为非Luminal型乳腺癌患者DFS的独立保护因素(HR=0.080,95%CI:0.010~0.627,P=0.016),TILs高比例患者3年无进展生存率高于TILs低比例患者(P=0.035)。结论:乳腺癌手术切除肿瘤组织中的TILs比例是预测非Luminal型乳腺癌预后的独立因素,TILs比例高的非Luminal型乳腺癌患者预后更好。

Objective:To observe the proportion of tumor infiltrating lymphocytes(tumor infiltrating lymphocytes,TILs)in breast cancer and to explore the relationship between the proportion of TILs and the clinicopathological features and prognosis in patients with breast cancer.Methods:The clinical data of female patients diagnosed as invasive ductal carcinoma of breast and undergone radical mastectomy in Qilu Hospital(Qingdao)of Shandong University from January 1,2015 to January 1,2017 were collected.The proportion of TILs in postoperative pathological specimens was calculated and divided into high and low groups.The relationship between TILs and clinicopathological features and prognosis was analyzed.Results:The proportion of TILs was higher in patients with hormone receptors negative than those with hormone receptors positive(P=0.000);the proportion of TILs in Her2(+)was significantly higher than that in Her2(-)(P=0.002);the proportion of TILs in non-Luminal type breast cancer(HER-2 overexpression and triple negative breast cancer)was significantly higher than Luminal type breast cancer(P=0.000).For non-Luminal type breast cancer,Kaplan-Meier univariate analysis showed that TILs fraction(P=0.035)and lymph node positive(P=0.000)were associated with DFS.Multivariate Cox regression analysis showed that lymph node positive was independent risk factor for DFS in non-Luminal type breast cancer patients(HR=2.021,95%CI:1.059~3.856,P=0.033),while high TILs fraction was independent protective factor for DFS in non-Luminal breast cancer patients(HR=0.080,95%CI:0.010~0.627,P=0.016),patients with high proportion of TILs had higher DFS%in 3 years than patients with low proportion of TILs(P=0.035).Conclusion:The proportion of TILs in postoperative pathology of breast cancer is an independent predictor of prognosis in non-Luminal type breast cancer patients.Non-Luminal breast cancer patients with a higher proportion of TILs have a better prognosis.