Impact of histopathology, tumor-infiltrating lymphocytes, and adjuvant chemotherapy on prognosis of triple-negative breast cancer

Autor: Heshan Liu, James N. Ingle, Abigail Thomas, Judy C. Boughey, Jenna Lilyquist, Judith A. Gilbert, David W. Hillman, Krishna R. Kalari, Margaret Akinhanmi, Fergus J. Couch, Mei Yin C. Polley, Minetta C. Liu, Roberto A. Leon-Ferre, Ahmed Elkhanany, Daniel W. Visscher, Vivian Negron, Matthew P. Goetz, Victoria Cafourek
Rok vydání: 2017
Předmět:
Adult
0301 basic medicine
Oncology
Cancer Research
medicine.medical_specialty
Receptor
ErbB-2
medicine.medical_treatment
Triple Negative Breast Neoplasms
Article
Disease-Free Survival
03 medical and health sciences
Lymphocytes
Tumor-Infiltrating
0302 clinical medicine
Breast cancer
Internal medicine
Biomarkers
Tumor
medicine
Humans
Neoplasm Invasiveness
Stage (cooking)
Triple-negative breast cancer
Aged
Neoplasm Staging
Proportional Hazards Models
Chemotherapy
business.industry
Tumor-infiltrating lymphocytes
Proportional hazards model
Estrogen Receptor alpha
Middle Aged
Prognosis
medicine.disease
030104 developmental biology
Chemotherapy
Adjuvant
Invasive carcinoma of no special type
030220 oncology & carcinogenesis
Female
Histopathology
Neoplasm Recurrence
Local
Receptors
Progesterone
business
Zdroj: Breast Cancer Research and Treatment. 167:89-99
ISSN: 1573-7217
0167-6806
Popis: Given its high recurrence risk, guidelines recommend systemic therapy for most patients with early-stage triple-negative breast cancer (TNBC). While some clinicopathologic factors and tumor-infiltrating lymphocytes (TILs) are known to be prognostic in patients receiving chemotherapy, their prognostic implications in systemically untreated patients remain unknown.From a cohort of 9982 women with surgically treated non-metastatic breast cancer, all patients with clinically reported ER-negative/borderline (≤10%) disease were selected for central assessment of ER/PR/HER2, histopathology, Ki-67, and TILs. The impact of these parameters on invasive disease-free survival (IDFS) and overall survival (OS) was assessed using Cox proportional hazards models.Six hundred five patients met the criteria for TNBC (ER/PR 1% and HER2 negative). Most were T1-2 (95%), N0-1 (86%), grade 3 (88%), and had a Ki-6715% (75%). Histologically, 70% were invasive carcinoma of no special type, 16% medullary, 8% metaplastic, and 6% apocrine. The median stromal TIL content was 20%. Four hundred twenty-three (70%) patients received adjuvant chemotherapy. Median OS follow-up was 10.6 years. On multivariate analysis, only higher nodal stage, lower TILs, and the absence of adjuvant chemotherapy were associated with worse IDFS and OS. Among systemically untreated patients (n = 182), the 5-year IDFS was 69.9% (95% CI 60.7-80.5) [T1a: 82.5% (95% CI 62.8-100), T1b: 67.5% (95% CI 51.9-87.8) and T1c: 67.3% (95% CI 54.9-82.6)], compared to 77.8% (95% CI 68.3-83.6) for systemically treated T1N0. Nodal stage and TILs remained strongly associated with outcomes.In early-stage TNBC, nodal involvement, TILs, and receipt of adjuvant chemotherapy were independently associated with IDFS and OS. In systemically untreated TNBC, TILs remained prognostic and the risk of recurrence or death was substantial, even for T1N0 disease.
Databáze: OpenAIRE
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