乳腺癌原发灶B淋巴细胞浸润与预后的关系  

Prognostic value of B lymphocyte infiltration in breast cancer

作　　者：于海明[1] 杨俊兰[1] 焦顺昌[1] 王建东[2] 

机构地区：[1]解放军总医院肿瘤内科,北京100853 [2]解放军总医院普通外科,北京100853

出　　处：《南方医科大学学报》2013年第5期750-755,共6页Journal of Southern Medical University

基　　金：吴阶平医学基金(320.6752.1230)

摘　　要：目的探讨早期乳腺癌原发灶B细胞与临床病理特征以及预后的关系。方法回顾性收集2000年1月～2002年12月在解放军总医院手术的130例Ⅰ～Ⅲ期乳腺癌患者的临床资料及石蜡切片,用免疫组织化学法检测乳腺癌原发灶间质中CD20阳性B淋巴细胞的浸润情况并分析其与CD8和CD4阳性淋巴细胞密度的关系,以及分析CD20阳性细胞浸润与乳腺癌临床病理特征及预后的关系。结果在部分乳腺癌(37.69%,49/130)间质可见CD20^+B细胞聚集分布,并可观察到CD3^+T细胞聚集在CD20^+B细胞聚集区的周围形成淋巴滤泡样结构。总体分析时,CD20^+细胞聚集与预后不相关。在激素受体阴性(雌激素受体和孕激素受体均为阴性)患者的COX多元分析中,CD20^+细胞聚集与较好的DDFS(HR=0.251,95%CI=0.071-0.894,P=0.033)、OS(HR=0.325,95%CI=0.103-1.028,P=0.056)相关。而在激素受体阳性(雌激素受体和孕激素受体至少有一个阳性)患者,CD20^+细胞聚集与DFS(P=0.997)、DDFS(P=0.759)、OS(P=0.700)均不相关。在激素受体阳性患者,术后辅助内分泌治疗可显著改善CD20^+细胞聚集阴性患者的OS(P=0.001)。结论 CD20^+细胞聚集在激素受体阴性乳腺癌患者有预后预测价值。术后辅助内分泌治疗的远期疗效与乳腺癌原发灶CD20^+细胞聚集相关,并进而影响CD20^+细胞聚集与乳腺癌预后的关系。Objective To assess the prognostic value of CD20＋ tumor-infiltrating lymphocytes （TILs） in early-stage breast cancer. Methods Paraffin sections were collected from 130 cases of stage I-III breast cancer undergoing surgery between January 2000 and December, 2002 in our hospital. Immunohistochemistry was used to analyze mesenchymal CD20＋ TILs infiltration in the tumor and evaluate its association with the density of CD4＋ and CD8＋ TILs. The association of CD20＋TILs was evaluated with the histopathologic features, overall survival （OS）, distant disease-free survival （DDFS）, and disease-free survival （DFS） of the patients. Results Aggregations of CD20~ lymphocytes were observed in 37.69% （49/130） of the cases. CD3＋ T cells were found to aggregate around CD20＋ B cell aggregations to form lymphoid follicle-like structures. The aggregations of CD20＋ TILs were positively correlated with the densities of mesenchymal CD8 ＋ and CD4 ＋ TILs. Overall, CD20 ＋ TIL aggregations were not significantly correlated with the outcomes of the patients, but multivariate COX regressions suggested that CD20 ＋ TIL aggregations were positively correlated with DDFS （HR=0.251, 95% CI=0.071-0.894, P=0.033） and OS （HR=0.325, 95% CI= 0.103-1.028, P=0.056） in hormone receptor-negative patients but not in the positive patients. Further analysis suggested that post-operative adjuvant endocrine therapy significantly improved the OS of patients positive for hormone receptors without CD20＋ TIL aggregations （P=0.001）. Conclusion The long-term therapeutic effects of adjuvant endocrine therapy are correlated with CD20＋ TIL aggregations to affect prognostic value of CD20＋ TIL aggregations in early-stage breast cancer patients.

关 键 词：乳腺肿瘤 免疫组化 CD20 CD8 CD4 无病生存 远处无转移生存 总生存 

分 类 号：R737.9[医药卫生—肿瘤]