Abstract
The potential role of abnormal ACE2 expression after SARS-CoV-2 infection in the prognosis of breast cancer is still ambiguous. In this study, we analyzed ACE2 changes in breast cancer and studied the correlation between ACE2 and the prognosis and further analyzed the relationship between immune infiltration and the prognosis of different breast cancer subtypes. Finally, we inferred the prognosis of breast cancer patients after SARS-CoV-2 infection. We found that ACE2 expression decreased significantly in breast cancer, except for basal-like subtype. Decreased ACE2 expression level was correlated with abnormal immune infiltration and poorer prognosis of luminal B breast cancer (RFS: HR 0.76, 95%CI=0.63-0.92, p=0.005; DMFS: HR 0.70, 95%CI=0.49-1.00, p=0.046). The expression of ACE2 was strongly positively correlated with the immune infiltration level of CD8+ T cell (r=0.184, p<0.001), CD4+ T cell (r=0.104, p=0.02) and neutrophils (r=0.101, p=0.02). ACE2 expression level in the luminal subtype was positively correlated with CD8A and CD8B markers in CD8+ T cells, and CEACAM3, S100A12 in neutrophils. In conclusion, breast tumor tissues might undergo a further decrease in the expression level of ACE2 after SARS-CoV-2 infection, which could contribute to further deterioration of immune infiltration and worsen the prognosis of luminal B breast cancer after SARS-CoV-2 infection.
Highlights
Breast cancer occupies the highest incidence of malignant tumors in women and one of the three most common cancers in the world [1,2,3,4]
We found that in luminal B breast cancer, higher expression level of ACE2 was corelated with better prognosis (RFS: HR 0.76, 95%CI=0.63-0.92, p=0.005; DMFS: HR 0.70, 95%CI=0.49-1.00, p=0.046)
The results showed that ACE2 expression level in the luminal subtype was positively correlated with CD8A and CD8B markers in CD8+ T cells, and CEACAM3, S100A12 in neutrophils (Table 1)
Summary
Breast cancer occupies the highest incidence of malignant tumors in women and one of the three most common cancers in the world [1,2,3,4]. Up to one in nine women may develop breast cancer during lifetime [5]. Breast cancer was considered as a tumor type with poor immunogenicity, so the role of immunity in its prognosis was not widely studied. In the past few years, some cases of breast cancer have presented to be strongly infiltrated by immune cells [7,8,9]. The presence of these immune cells has an important predictive value in the prognosis of breast cancer patients
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