The relationship between lymphocyte subsets and clinico-pathological determinants of survival in patients with primary operable invasive ductal breast cancer.
The relationship between lymphocyte subsets and clinico-pathological determinants of survival in patients with primary operable invasive ductal breast cancer.
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DOI：
10.1038/bjc.2013.493
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发表时间：
2013-09-17
影响因子：
8.8
通讯作者：
McMillan, D. C.
中科院分区：
文献类型：
--
作者：
Mohammed, Z. M. A.;Going, J. J.;Edwards, J.;Elsberger, B.;McMillan, D. C.
淋巴细胞亚型在决定原发性可手术导管浸润性乳腺癌预后中的重要性尚不清楚。本研究旨在探讨原发性可手术浸润性导管乳腺癌患者肿瘤淋巴细胞亚群浸润与标准临床病理因素及生存率的关系。采用免疫组织化学技术和视觉定量及半定量技术对338例导管性乳腺癌患者的炎性细胞浸润进行了分析，包括淋巴细胞亚型。大多数（91%）患者有高度炎症细胞浸润。幸存者的中位随访时间为164个月。在此期间，65人死于癌症。单因素分析显示，肿瘤炎性细胞浸润、巨噬细胞浸润（P<0.05）、淋巴细胞浸润（P<0.001）和CD8+ t淋巴细胞浸润（P<0.01）与肿瘤特异性生存相关，而中性粒细胞浸润（P<0.05）和CD138+ b淋巴细胞浸润（P<0.001）与肿瘤特异性生存相关。多因素分析显示，肿瘤淋巴细胞浸润（P<0.001）、巨噬细胞浸润（P<0.05）、CD8+ t淋巴细胞浸润（P<0.01）和CD138+ b淋巴细胞浸润（P<0.001）与肿瘤生存独立相关。在多因素分析中，当将显著炎症细胞类型与肿瘤相关因素合并时，仅考虑肿瘤大小（风险比（HR）： 2.55, 95%可信区间（CI）： 1.53-4.27， P<0.001）、Ki-67指数（HR: 2.08, 95% CI: 1.08-4.00， P<0.05）、淋巴血管浸润（HR: 4.40, 95% CI: 2.07-9.35， P<0.001）、巨噬细胞浸润（HR: 0.49, 95% CI: 0.33-0.73， P<0.001）、淋巴细胞浸润（HR: 0.11, 95% CI: 0.05 - 0.23， P<0.001）、CD8+ t淋巴细胞浸润（HR: 0.57, 95% CI: 0.05）；0.38 ~ 0.87， P<0.001)和CD138+ b淋巴细胞浸润（HR: 2.86, 95% CI: 1.79 ~ 4.56， P<0.001）与肿瘤生存独立相关。大多数浸润性导管性乳腺癌患者有高度炎性细胞浸润。在这些患者中，包括巨噬细胞和淋巴细胞浸润在内的炎症细胞，以及CD8+ t淋巴细胞浸润和CD138+ b淋巴细胞浸润亚群，与激素状态和淋巴结累及相比，在原发性可手术浸润性导管乳腺癌患者中具有更好的预后价值。
The importance of lymphocyte subtypes in determining outcome in primary operable ductal invasive breast cancer remains unclear. The aim of present study was to examine the relationship between tumour lymphocyte subsets infiltrate and standard clinico-pathological factors and survival in patients with primary operable invasive ductal breast cancer. The analysis of the inflammatory cell infiltrate, including lymphocyte subtypes, was undertaken using immunohistochemical techniques and visual quantitative and semi-quantitative techniques in 338 patients with ductal breast cancer. The majority (91%) of patients had high grade inflammatory cell infiltrate. The median follow-up of the survivors was 164 months. During this period, 65 died of their cancer. On univariate analysis, tumour inflammatory cell infiltrate, macrophages infiltrate (P<0.05), lymphocytic infiltrate (P<0.001) and CD8+ T-lymphocytic infiltrate (P<0.01) were associated with improved cancer-specific survival, whereas neutrophil (P<0.05) and CD138+ B-lymphocytic infiltrate (P<0.001) were associated with poorer cancer-specific survival. On multivariate analysis, tumour lymphocytic infiltrate (P<0.001), macrophage infiltrate (P<0.05), CD8+ T-lymphocytic infiltrate (P<0.01) and CD138+ B-lymphocytic infiltrate (P<0.001) were independently associated with cancer survival. When the significant inflammatory cell types were included with tumour-based factors in multivariate analysis only tumour size (Hazard ratios (HR): 2.55, 95% confidence interval (CI): 1.53–4.27, P<0.001), Ki-67 index (HR: 2.08, 95% CI: 1.08–4.00, P<0.05), lymphovascular invasion (HR: 4.40, 95% CI: 2.07–9.35, P<0.001), macrophage infiltrate (HR: 0.49, 95% CI: 0.33–0.73, P<0.001), lymphocytic infiltrate (HR: 0.11, 95% CI: 0.05–0.23, P<0.001), CD8+ T-lymphocytic infiltrate (HR: 0.57, 95% CI: 0.38–0.87, P<0.001) and CD138+ B-lymphocytic infiltrate (HR: 2.86, 95% CI: 1.79–4.56, P<0.001) were independently associated with cancer survival. The majority of patients with invasive ductal breast cancer had high-grade inflammatory cell infiltrate. In these patients, inflammatory cells including macrophage and lymphocytic infiltrate, and subsets CD8+ T-lymphocytic infiltrate and CD138+ B-lymphocytic infiltrate had superior prognostic value, compared with hormone status and lymph node involvement in patients with primary operable invasive ductal breast cancer.
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