Tumor-infiltrating Lymphocytes are Independent Favorable Prognostic Indicator in 17-year Disease-Free Survival in Lymph Node-Negative Triple-Negative Breast Cancer Patient
Ana Lucia Amaral Eisenberg *
Pathology Division (DIPAT), Nacional Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Santo Cristo, Rio de Janeiro, RJ, CEP: 20220-400, Brazil
Leila Chimelli
Pathology Division (DIPAT), Nacional Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Santo Cristo, Rio de Janeiro, RJ, CEP: 20220-400, Brazil
Mirian Carvalho de Souza
Epidemiology Division, Nacional Cancer Institute (INCA), Rua Marquês de Pombal, 125, 7th floor, Centro, Rio de Janeiro, RJ, CEP: 20230-240, Brazil
Fernanda Maria Braga Marinho
Mastology, Hospital do Câncer III, Nacional Cancer Institute (INCA), Rua Visconde de Santa Isabel, 274, Vila Isabel, Rio de Janeiro, RJ, CEP: 20560-120, Brazil
Maria Theresa Accioly
Pathology Division (DIPAT), Nacional Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Santo Cristo, Rio de Janeiro, RJ, CEP: 20220-400, Brazil
Marcelli Gatto de Brito
Pathology Division (DIPAT), Nacional Cancer Institute (INCA), Rua Cordeiro da Graça, 156, Santo Cristo, Rio de Janeiro, RJ, CEP: 20220-400, Brazil
Sérgio Koifman
Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation (FIOCRUZ), Brazil
Eliana Abdelhay
Stem Cell Laboratory, Bone Marrow Transplantation Unit, Nacional Cancer Institute (INCA), Praca Cruz Vermelha, 23, Centro, CEP: 20230-130, Rio de Janeiro, RJ, Brazil
*Author to whom correspondence should be addressed.
Abstract
Aims: To estimate the prognostic value of tumor-infiltrating lymphocytes, among other variables, in triple-negative breast cancer patients with a 17-year disease-free survival.
Study Design: A retrospective study of 79 patients was conducted to investigate treatment, and clinical, microscopic and immunohistochemical tumor characteristics.
Place and Duration of Study: Pathology Division, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil, between January 1992 and December 1996.
Methodology: Histologically diagnosed 79 node-negative triple-negative breast cancer patients underwent partial or total mastectomy with axillary lymphadenectomy, with or without radiotherapy, chemotherapy and/or hormone therapy. Disease-free survival was estimate by the Kaplan-Meier method and log-rank test. Prognostic variables were obtained by Cox regression models.
Results: The 17-year disease-free survival was 50.6%. Disease-free survival was worse in patients aged 51-82 years, who underwent neoadjuvant chemotherapy and had skin compromise, geographic necrosis, grade 3 tumors, had no tumor-infiltrating lymphocytes, had vascular/lymphatic invasion, CD44+/CD24-/low and elevated Ki-67. The risk of recurrence and/or metastasis, adjusted for the remaining variables of the final Cox model was 2.44 times higher for patients aged 51-82 years, 2.60 times higher for patients undergoing neoadjuvant chemotherapy, 3.97 times higher for grade 3 tumors and 0.34 times for patients with tumor-infiltrating lymphocytes.
Conclusion: The risk of recurrence and/or metastasis, adjusted for the remaining variables of the model, was about 2.5 times higher for older patients undergoing neoadjuvant chemotherapy. In grade 3 tumor patients, the risk increased almost fourfold. Patients with tumor-infiltrating lymphocytes had a 66% lower risk, i.e, tumor-infiltrating lymphocytes were shown to be a protective factor.
Keywords: Axillary lymph nodes, breast cancer, immunohistochemistry, prognosis, survival, triple-negative breast cancer, tumor-infiltrating lymphocytes