Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer.
Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer.
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DOI：
10.1158/1078-0432.ccr-17-1323
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发表时间：
2018-06-15
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影响因子：
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通讯作者：
Kurian AW
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作者：
Afghahi A;Purington N;Han SS;Desai M;Pierson E;Mathur MB;Seto T;Thompson CA;Rigdon J;Telli ML;Badve SS;Curtis CN;West RB;Horst K;Gomez SL;Ford JM;Sledge GW;Kurian AW
预处理活检中的肿瘤浸润淋巴细胞（TIL）与三阴性乳腺癌（TNBC）的生存率提高有关。我们研究了高外周血淋巴细胞计数是否与TNBC中较低的乳腺癌特异性死亡率（BCM）和总死亡率（OM）相关。来自两个卫生保健系统的电子医疗记录的治疗和诊断测试数据与来自加州癌症登记处的人口统计、临床、病理和死亡率数据相关联。使用多变量回归模型调整年龄、种族/民族、社会经济地位、癌症分期、分级、新辅助/辅助化疗使用、放疗使用和种系BRCA1/2突变来评估绝对淋巴细胞计数（ALC）、BCM和OM之间的关系。对于一个有TIL数据的亚组，我们探讨了TIL与外周血淋巴细胞计数之间的关系。2000年至2014年，共有1463名I-III期TNBC患者被诊断；1113例（76%）患者在诊断1年内接受了新辅助/辅助化疗。在759例可获得ALC数据的患者中，481例（63.4%）存在淋巴细胞减少（最小ALC <1.0 K/µL）。在多变量分析中，较高的最小ALC，而不是绝对中性粒细胞计数，预测较低的OM [HR=0.23；95%可信区间（CI）， 0.16 - 0.35]和BCM （HR=0.19； CI, 0.11-0.34）。曾经淋巴细胞减少的患者5年发生BCM的概率为15%，而没有淋巴细胞减少的患者为4%。一项探索性分析（n=70）显示，在新辅助化疗期间，TILs与较高的外周血淋巴细胞计数之间存在显著关联。较高的外周血淋巴细胞计数预示着早期可治愈的TNBC死亡率较低，这表明免疫功能可能增强早期TNBC治疗的有效性。
Tumor-infiltrating lymphocytes (TIL) in pretreatment biopsies are associated with improved survival in triple-negative breast cancer (TNBC). We investigated whether higher peripheral lymphocyte counts are associated with lower breast cancer–specific mortality (BCM) and overall mortality (OM) in TNBC. Data on treatments and diagnostic tests from electronic medical records of two health care systems were linked with demographic, clinical, pathologic, and mortality data from the California Cancer Registry. Multivariable regression models adjusted for age, race/ethnicity, socioeconomic status, cancer stage, grade, neoadjuvant/adjuvant chemotherapy use, radiotherapy use, and germline BRCA1/2 mutations were used to evaluate associations between absolute lymphocyte count (ALC), BCM, and OM. For a subgroup with TIL data available, we explored the relationship between TILs and peripheral lymphocyte counts. A total of 1,463 stage I–III TNBC patients were diagnosed from 2000 to 2014; 1, 113 (76%) received neoadjuvant/adjuvant chemotherapy within 1 year of diagnosis. Of 759 patients with available ALC data, 481 (63.4%) were ever lymphopenic (minimum ALC <1.0 K/µL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR=0.23; 95% confidence interval (CI), 0.16– 0.35] and BCM (HR=0.19; CI, 0.11–0.34). Five-year probability of BCM was 15% for patients who were ever lymphopenic versus 4% for those who were not. An exploratory analysis (n=70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy. Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment.