Abstract
ObjectiveOur purpose is to evaluate the correlation of TILs with clinicopathological characteristics and disease free survival (DFS) in DCIS and DCIS-Mi breast cancer (BC) patients.MethodsWe retrospectively reviewed the data of 360 DCIS patients and 125 DCIS-Mi patients treated by a single institution from 2016 to 2019. TILs are regarded as continuous variables and are divided into low (≤ 5%), medium (5–40%) and high (≥ 40%) for statistical analysis.ResultsIn DCIS and DCIS-Mi patients, larger tumor size, higher nuclear grade, hormone receptor (HR) negativity and human epidermal growth factor receptor 2(HER2) overexpression are all related to high TILs (P < 0.05). In addition, compared with DCIS, DCIS-Mi patients were significantly associated with high TILs (P < 0.001). Based on the different results of the subtypes, we further studied the correlation between TILs and DFS in 279 cases of HER2+ patients (204 of DCIS; 75 of DCIS-Mi). In HER2+ group, DCIS-Mi was significantly associated with HR negativity (P = 0.015) and high TILs (P = 0.002) compared with DCIS patients. In the survival analysis, we found that TILs had no effect on the DFS of DCIS (P = 0.938), DCIS-Mi (P = 0.807), and HER2+ (P = 0.379) BC patients. In the univariate and multivariate cox regression analysis, the correlation between TILs and the prognosis of DFS has not been confirmed in the three BC groups (P > 0.05).ConclusionTILs have played an non-negligible role in the progress of DCIS to DCIS-Mi, especially in HER2+ BC. The predictive and prognostic value of TILs still needs further research to confirm.
Highlights
With the increase of public awareness of breast cancer (BC) screening and the widespread use of mammograms, the detection rate of DCIS has greatly increased, accounting for about 20–25% of BC [1]
We found that in the HER2+ group, DCIS-Mi patients were younger than DCIS, but the difference was not statistically significant (P = 0.218).It is valuable that DCIS-Mi patients are associated with larger tumor size (P < 0.001), hormone receptor (HR) negativity (P = 0.015), higher Ki-67 index (P = 0.003) and higher TILs density (P = 0.002).There are differences in surgical options between the two groups of BC patients
We found that TILs has no prognostic value for DCIS (P = 0.938), DCIS-Mi (P = 0.807) and HER2+ (P = 0.379) BC patients
Summary
With the increase of public awareness of BC screening and the widespread use of mammograms, the detection rate of DCIS has greatly increased, accounting for about 20–25% of BC [1]. Among DCIS lesions, micro-invasive lesions (≤ 1 mm) can be found in about 5–10% of DCIS, which we call DCIS-Mi. In general, approximately 50% of invasive breast cancer (IBC) have progressed from DCIS [2]. As an important part of TME, TILs mainly include T cells, B cells, and natural killer (NK) cells. T cells dominate adaptive immunity is the key to effective and sustained antitumor response. TILs have been described in many solid tumors including BC. Stromal TILs have been proven to be a valuable and independent prognostic indicator in triple-negative breast cancer (TNBC) [5]. In TNBC and HER2+ patients receiving neoadjuvant chemotherapy (NAC), high density TILs are associated with higher pathologic complete response (pCR) rate and better survival benefits [6]. Immune cell infiltration of tumor is usually an early event of BC.
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