4.7 Article

Prognostic and predictive significance of tumor infiltrating lymphocytes for ductal carcinoma in situ

Journal

ONCOIMMUNOLOGY
Volume 10, Issue 1, Pages -

Publisher

TAYLOR & FRANCIS INC
DOI: 10.1080/2162402X.2021.1875637

Keywords

Ductal carcinoma in situ; tumor-infiltrating lymphocytes; radiotherapy; individualized local therapy

Funding

  1. National Natural Science Foundation of China [81673102, 81602791, 81803164]
  2. National Key Research and Development Program of China [2016YFC0105409]
  3. Youth Foundation of Shanghai Health and Family Planning Commission [20164Y0066]
  4. Shanghai Municipal Education Commission-Gaofeng Clinical Medicine Grant Support [20171904]
  5. special construction of integrated Chinese and Western medicine in general hospital [ZHYY-ZXYJHZ X-2-201704, ZHYY-ZXYJHZ X-2-201913]

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The density of Touching-TILs in DCIS patients is an important prognostic factor, with high density associated with unfavorable biologic characteristics and increased risk of ipsilateral breast tumor recurrence.
This study aims to identify the density of TILs in ductal carcinoma in situ (DCIS) in terms of prognostic significance with recurrence and the benefit of whole breast irradiation (WBI). The clinicopathological data of DCIS patients from Jan 2009 to Dec 2016 who received breast-conserving surgery (BCS) were retrospectively reviewed. Cox regression analysis was used to confirm independent prognostic factors of ipsilateral breast tumor recurrence (IBTR). Kaplan-Meier method was utilized to analyze IBTR and values of WBI. Touching-tumor-infiltrating lymphocytes (TILs) were defined by TILs touching or within one lymphocyte cell thickness from the malignant ducts' basement membrane. In total, 129 patients were enrolled in this analysis with 98 patients who received WBI. After a median follow-up of 53.0 months, there were 16 IBTR events with five invasive IBTRs. Univariate and multivariate analyses showed that touching-TILs >5 were an independent prognostic factor for higher IBTR (HR = 6.17, 95%CI 1.95-19.56, p < .01). The whole cohort was classified into two subgroups: dense group (>5 touching-TILs per duct) and sparse group (<= 5 touching-TILs per duct). Dense touching-TILs were associated with unfavorable biologic characteristics. The 5-y rate of IBTR between dense and sparse group was 29.0% versus 4.5% (p < .01). For the sparse group, WBI significantly reduced the rate of 5-y-IBTR risk from 13.2% to 1.7% (p = .02), but there was no benefit of WBI in the dense group. Touching-TILs density was heterogeneous in patients with DCIS. Sparse touching-TILs were associated with better prognosis and benefit from WBI. Dense touching-TILs not only were associated with a higher risk of IBTR but also lack of benefit from WBI.

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