HER2阳性型乳腺癌肿瘤间质淋巴细胞浸润程度表达的临床病理意义

Clinicopathological significance of expression level of tumor-infiltrating lymphocytes in patients with HER2 positive breast cancer

目的探讨人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性型乳腺癌患者肿瘤浸润淋巴细胞(tumor infiltrating lymphocytes,TILs)表达与临床病理特征的相关性及与患者预后的关系。方法收集滕州市中心人民医院2016年10月至2018年10月期间收治的HER2阳性型乳腺癌患者,共94例,均为女性,中位年龄51岁(32~73岁)。其中,49例患者接受曲妥珠单抗靶向治疗和化疗,45例患者仅接受化疗;评估每位患者HE切片肿瘤区域内TILs浸润程度,使用χ^(2)检验对分类资料进行统计分析,使用Kaplan-Meier生存曲线和Cox回归法行单因素和多因素分析,分析TILs浸润程度与患者临床病理特征的关系和对患者无复发生存期(recurrence-free survival,RFS)的影响。结果94例HER2阳性型乳腺癌患者,61例呈轻度浸润,33例呈重度浸润。TILs浸润程度与各临床病理参数均无明显相关性(均P>0.05)。靶向治疗组:32例呈轻度浸润,17例呈重度浸润。TILs重度浸润患者RFS长于TILs轻度浸润者(P=0.036);TNM分期和TILs浸润程度均是HER2阳性型乳腺癌患者预后的独立因素(P=0.003、P=0.029)。普通化疗组:29例呈轻度浸润,16例呈重度浸润。TILs重度浸润者的RFS长于TILs轻度浸润者(P=0.049);TNM分期和TILs浸润程度均是患者预后相关的独立因素(P=0.001、P=0.028)。结论TILs可作为HER2阳性型乳腺癌预测预后和治疗效果的肿瘤标志物,并有可能成为肿瘤新的治疗靶点。

Objective To investigate the relationship between the expression of tumor-infiltrating lymphocytes(TILs)and clinicopathological characteristics,and the effect of TILs on prognosis in patients with human epidermal growth factor receptor 2(HER2)positive breast cancer.Methods A total of 94 female patients with HER2 positive breast cancer treated at Tengzhou Central People's Hospital from October 2016 to October 2018 were collected,with a median age of 51 years(32-73 years).Among them,49 patients took trastuzumab and chemotherapy,and 45 chemotherapy.The degree of TILs in the tumor area of each patient's HE section was evaluated.χ^(2) test was used to analyze the category data.The Kaplan Meier survival curve and Cox proportional hazard regression model were used to analyze the prognostic factors.The relationship between the degree of TILs and the clinicopathological characteristics and the effect of TILs on the patients'recurrence free survival(RFS)were analyzed.Results Among the 94 patients,61 had low infiltration,and 33 high infiltration.There were no significant correlations between the degree of TILs and clinical pathological parameters(all P>0.05).In the targeted therapy group,32 cases had low infiltration,and 17 cases high infiltration.The RFS of the patients with high TILs was longer than that of the patients with with low TILs(P=0.036);TNM stage and the degree of TILs were independent factors for the patients'prognosis(P=0.003 and 0.029).In the general chemotherapy group,29 cases had low infiltration,and 16 cases high infiltration.The RFS of the patients with high TILs was longer than that of the patients with with low TILs(P=0.049);TNM stage and TILs were independent factors related to the patients'prognosis(P=0.001 and 0.028).Conclusions TILs can be used as tumor markers in predicting the prognosis and therapeutic effect of patients with HER2 positive breast cancer,and may become new therapeutic targets for tumors.