不同分子亚型乳腺癌患者肿瘤浸润淋巴细胞水平与新辅助化疗预后的关系

Relationship between tumor-infiltrating lymphocyte levels and neoadjuvant chemotherapy prognosis in breast cancer patients with different molecular subtypes

摘要:

目的 探讨不同分子亚型乳腺癌患者肿瘤浸润淋巴细胞（TIL）水平与新辅助化疗预后的关系。方法 回顾性选取2023年6月—2024年11月在青海红十字医院接受新辅助化疗并手术的153例女性乳腺癌患者的临床资料。记录患者的分子亚型［Luminal型、人表皮生长因子受体2（HER2）阳性型、三阴性乳腺癌（TNBC）］，并根据TILs比例将患者分为低（<10%）、中（10%～50%）、高（>50%）3组。术后随访1年，将出现复发或死亡的患者归为预后不良组，其余为预后良好组，采用单因素分析和多因素一般Logistic回归模型分析TILs水平与预后的关系。结果 低TILs组、中TILs组和高TILs组乳腺癌不同分子亚型构成比较，差异有统计学意义（P <0.05）。预后不良组与预后良好组淋巴结转移率、TILs水平构成和分型构成比较，差异均有统计学意义（P <0.05）；预后不良组患者淋巴结转移率、TILs水平中高占比和ER2阳性型及TNBC型占比均高于预后良好组。多因素一般Logistic回归分析结果显示：淋巴结转移［O^R =2.933（95% CI：1.358，6.334）］、TILs水平等级高［O^R =8.228（95% CI：1.759，38.482］、HER2阳性型［O^R =2.511（95% CI：1.093，5.956）］和TNBC分型［O^R =7.949（95% CI：2.929，21.571）］均为患者预后不良的危险因素（P <0.05）。结论 TNBC患者的TILs水平显著升高，且TILs水平升高是乳腺癌患者新辅助化疗后预后不良的独立风险因素。

Abstract:

Objective This study aims to explore the relationship between tumor-infiltrating lymphocyte (TIL) levels and neoadjuvant chemotherapy prognosis in breast cancer patients with different molecular subtypes.Methods A retrospective collection was conducted on the clinical data of 153 female breast cancer patients who received neoadjuvant chemotherapy followed by surgery in our hospital from June 2023 to November 2024. The molecular subtypes (Luminal, HER2-positive, triple-negative breast cancer) were recorded, and patients were divided into low (< 10%), medium (10% - 50%), and high (> 50%) TILs level groups based on the proportion of TILs. Patients were followed up for one year postoperatively; those with recurrence or death were classified into the poor prognosis group, and the others into the good prognosis group. The relationship between TILs levels and prognosis was analyzed.Results Comparison of the different molecular subtypes of breast cancer among the low, moderate, and high TILs groups showed a statistically significant difference (P < 0.05). Comparison of lymph node metastasis rate, TILs level composition, and molecular subtype composition between the poor prognosis group and the good prognosis group revealed statistically significant differences by the chi-square test (P < 0.05). The lymph node metastasis rate, the proportion of moderate-to-high TILs levels, and the proportions of HER2-positive and TNBC subtypes were higher in the poor prognosis group than in the good prognosis group. Logistic regression analysis results indicated that lymph node metastasis [O^R = 2.933 (95% CI: 1.358, 6.334) ], high TILs level [O^R = 8.228 (95% CI: 1.759, 38.482) ], HER2-positive subtype [O^R = 2.511 (95% CI: 1.093, 5.956) ], and TNBC subtype [O^R=7.949 (95% CI: 2.929, 21.571) ] were all risk factors for poor patient prognosis (P < 0.05).Conclusion TILs levels are significantly elevated in triple-negative breast cancer patients, and higher TILs levels are an independent risk factor for poor prognosis after neoadjuvant chemotherapy in breast cancer patients.