肿瘤间质比和肿瘤间质浸润淋巴细胞对HER2阴性乳腺癌新辅助治疗疗效的影响  

Effect of tumor-stroma ratio and stromal tumor-infiltrating lymphocytes on the efficacy of neoadjuvant therapy for HER2-negative breast cancer

作　　者：张玲玲[1,2] 张勐 李赛男[2,3] 蔡丽静 韩丹丹[1] 刘月平 ZHANG Lingling;ZHANG Meng;LI Sainan;CAI Lijing;HAN Dandan;LIU Yueping(Department of Pathology,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China;Hebei Key Laboratory of Breast Cancer Molecular Medicine,Shijiazhuang 050011,China;Breast Center Department,the Fourth Hospital of Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院病理科,石家庄050011 [2]河北省乳腺癌分子医学重点实验室,石家庄050011 [3]河北医科大学第四医院乳腺中心,石家庄050011

出　　处：《临床与实验病理学杂志》2024年第11期1154-1161,共8页Chinese Journal of Clinical and Experimental Pathology

基　　金：河北省卫健委医学科学研究课题(20210439)。

摘　　要：目的探讨肿瘤间质比(tumor-stroma ratio,TSR)和肿瘤间质浸润淋巴细胞(stromal tumor-infiltrating lymphocytes,sTILs)对HER2阴性乳腺癌新辅助治疗(neoadjuvant therapy,NAT)疗效的预测意义。方法收集516例术前穿刺确诊为HER2阴性乳腺浸润性癌患者,均接受NAT后进行根治性手术。评估常规HE切片中TSR和sTILs的状态,术后标本进行残余肿瘤负荷(residual cancer burden,RCB)分级、Miller-Payne(MP)分级、病理完全缓解(pathological complete response,pCR)评估。采用Pearsonχ^(2)和趋势χ^(2)检验观察TSR、sTILs、TSR联合sTILs与临床病理特征的关系;应用Logistic二元回归分析TSR、sTILs、TSR联合sTILs与pCR率的关系。结果516例乳腺癌中高TSR(间质占比≤50%)者278例(53.9%),低TSR(间质占比>50%)者238例(46.1%)。NAT前高TSR组和高sTILs组的肿瘤与较高的MP分级、较低的RCB分级显著相关,pCR率高(P<0.05)。术前活检高TSR患者pCR的概率比低TSR患者高2.163倍(OR:2.163,95%CI:1.201~3.898,P=0.010)。激素受体(hormone receptor,HR)阴性组、高TSR对NAT后患者pCR率的OR值为2.999(95%CI:1.216~7.396,P=0.017)。高TSR、高sTILs组患者NAT后pCR率是低TSR、低sTILs患者的4.052倍(OR:4.052,95%CI:1.900~8.644,P<0.001),差异均有统计学意义。结论HER2阴性乳腺癌患者治疗前活检中较高的TSR和sTILs状态与NAT后较高的MP分级和较低的RCB分级、较高的pCR率相关,术前联合评估两者可为临床治疗提供帮助。Purpose To investigate the predictive significance of tumor-stroma ratio(TSR)and stromal tumor-infiltrating lymphocytes(sTILs)in neoadjuvant therapy(NAT)for HER2-negative breast cancer.Methods A total of 516 patients with HER2-negative invasive breast cancer by preoperative puncture were collected,and all of them underwent radical surgery after receiving NAT.TSR and sTILs in breast cancer tissue were evaluated on routine HE sections of biopsy,and residual cancer burden(RCB)grading,Miller-Payne(MP)grading and pathological complete response(pCR)assessment were carried out in postoperative specimens.Associations between the TSR,sTILs,TSR combined with sTILs and clinicopathological features were examined using Pearson’s chi-square,and the relationships with chemotherapy response were analyzed by linear by linear association.Logistic binary regression analysis was used to analyze the association between TSR,sTILs,TSR combined with sTILs and pCR rate.Results Among the 516 cases of breast cancer,278 cases(53.9%)had a high TSR(tumor stromal area≤50%)and 238 cases(46.1%)had a low TSR(tumor stromal area>50%).Tumors in TSR-high groups and sTILs-high groups before NAT were significantly associated with higher MP grade and lower RCB grade,as well as higher pCR rate(P<0.05).The probability of obtaining pCR in patients with high TSR in preoperative biopsy was 2.163 times higher than that in patients with low TSR(OR:2.163,95%CI:1.201-3.898,P=0.010).In the hormone receptor(HR)-negative group,the OR value of pCR rate in patients with high TSR was 2.999(95%CI:1.216-7.396,P=0.017).The pCR rate after NAT in patients with TSR-high and sTILs-high groups was 4.052 times higher than that in patients with TSR-low and sTILs-low(OR:4.052,95%CI:1.900-8.644,P<0.001),and the difference was statistically significant.Conclusion Higher TSR and sTILs status in pretreatment biopsies of HER2-negative breast cancer patients are associated with higher MP grade,lower RCB grade and higher pCR rate after NAT,and preoperative joint evaluation of both

关 键 词：乳腺肿瘤 HER2阴性乳腺癌 新辅助治疗 肿瘤间质比 肿瘤间质浸润淋巴细胞 RCB分级 病理完全缓解 

分 类 号：R737.9[医药卫生—肿瘤]