Abstract
BackgroundBreast cancer subtypes are known to have different metastatic recurrence sites. Distant metastases are often observed during the post-operative course in patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer and triple-negative breast cancer, but are relatively rare in those with hormone receptor-positive and HER2-negative (HR+/HER2−) breast cancer. Tumor-infiltrating lymphocytes (TILs) serve as an index to monitor tumor immune microenvironment and may possibly predict the prognosis and therapeutic effect in breast cancer. This study aimed to investigate the correlation between TIL density and recurrence site in HR+/HER2− breast cancer.MethodsIn stages I–II of HR+/HER2− breast cancer patients who underwent surgery as the first treatment and received adjuvant endocrine therapy (except adjuvant chemotherapy), forty-two patients relapsed after surgery. TILs were evaluated using needle biopsy specimens for the diagnosis of breast cancer. Morphological assessment was conducted using conventional hematoxylin and eosin staining.ResultsSix patients had no TILs density. In them, local recurrence was significantly less (p = 0.022), while distant metastases were significantly more (p = 0.015) compared to those in patients with TIL density. Therefore, for the prediction of distant metastases in HR+/HER2− breast cancer without chemotherapy, TILs could be used as predictors in univariate analysis (p = 0.015, odds ratio [OR] = 0.127), although not as independent factors (p = 0.285, OR = 0.144).ConclusionsOur findings indicate that TILs may predict distant metastatic recurrence in stages I–II of HR+/HER2− breast cancer in patients who do not undergo chemotherapy.
Highlights
Breast cancer subtypes are known to have different metastatic recurrence sites
Distant metastases are frequently found during the post-operative course in patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer and triple-negative breast cancer (TNBC), while they are relatively rare in patients with hormone receptor-positive and HER2-negative (HR+/HER2−) breast cancer
The median tumor size was 20.5 mm (9.5–49.3 mm), and no evidence of axillary lymph node metastasis was found by pre-operative imaging, in all cases
Summary
Breast cancer subtypes are known to have different metastatic recurrence sites. Distant metastases are often observed during the post-operative course in patients with human epidermal growth factor receptor 2 (HER2)enriched breast cancer and triple-negative breast cancer, but are relatively rare in those with hormone receptorpositive and HER2-negative (HR+/HER2−) breast cancer. This study aimed to investigate the correlation between TIL density and recurrence site in HR+/HER2− breast cancer. Distant metastases are frequently found during the post-operative course in patients with human epidermal growth factor receptor 2 (HER2)-enriched breast cancer and triple-negative breast cancer (TNBC), while they are relatively rare in patients with hormone receptor-positive and HER2-negative (HR+/HER2−) breast cancer. A correlation between TILs and lymph node metastasis was reported in gastric cancer and melanoma [10, 11], and that between TILs and axillary lymph node metastasis was reported in TNBC [12, 13] In all these reports, lower TIL density was shown to more likely cause lymph node metastasis. We speculate that if TILs are involved in lymph node metastasis, which is a risk factor for distant metastasis, TILs should be involved in distant metastasis
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