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Predictive value of tumor-infiltrating lymphocytes for pathological response to neoadjuvant chemotherapy in breast cancer patients with axillary lymph node metastasis

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Abstract

Purpose

We investigated the role of tumor-infiltrating lymphocytes (TILs) in pretreatment primary breast cancer to predict pathological response to neoadjuvant chemotherapy (NAC) in patients with clinical node-positive disease (cN +).

Methods

The subjects of this study were 60 patients with cN + , who received NAC followed by breast surgery with axillary lymph node dissection (ALND). We conducted a semi-quantitative assessment of TILs in pretreatment primary tumors and their association with clinicopathological factors and axillary lymph node metastasis.

Results

We observed a higher number of TILs in tumors with negative hormone receptors, positive human epidermal growth factor receptor 2, or high Ki67. TILs were associated with a favorable response to NAC in primary tumors. The rate of axillary pathologic complete response (Ax-pCR) was significantly higher in patients with a high number of TILs than in patients with a low number of TILs (72.0% versus 17.1%, p < 0.001). In multivariable analysis, a high number of TILs was a significant predictor of Ax-pCR as well as of pCR of the primary tumor after NAC. Importantly, all patients with HER2-positive tumors in the high TILs group showed Ax-pCR on ALND.

Conclusion

TILs in pretreatment primary breast cancer had the potential to predict therapeutic efficacy of NAC in patients with clinical node-positive disease.

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Acknowledgements

We thank Katsuhiko Yamamoto (Gakken Nara Breast Clinic, Nara, Japan) for his helpful advice regarding data management.

Funding

This study was supported in part by JSPS KAKENHI Grant Number JP18K08548.

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan

    Tomoyo Yokotani, Noaya Ikeda, Tomoko Hirao, Yukimi Tanaka, Toyoki Kobayashi & Masayuki Sho

  2. Department of Diagnostic Pathology, Nara Medical University, Nara, Japan

    Kohei Morita, Tomomi Fujii & Chiho Ohbayashi

  3. Department of Breast Surgery, Nabari City Hospital, Mie, Japan

    Takashi Nakamura

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  1. Tomoyo Yokotani
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Correspondence to Noaya Ikeda.

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Conflict of interest

We have no conflicts of interest to declare with respect to the research, authorship, and publication of this article.

Ethics statement

This study was conducted at the Nara Medical University, Nara, Japan. Sufficient explanation was provided, and written, informed consent was obtained from all study subjects for their involvement in this study and for the storage and use of their data. The study protocol was approved by the ethics committee of the Nara Medical University (No. 2386) in accordance with the Declaration of Helsinki.

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Yokotani, T., Ikeda, N., Hirao, T. et al. Predictive value of tumor-infiltrating lymphocytes for pathological response to neoadjuvant chemotherapy in breast cancer patients with axillary lymph node metastasis. Surg Today 51, 595–604 (2021). https://doi.org/10.1007/s00595-020-02157-6

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  • DOI: https://doi.org/10.1007/s00595-020-02157-6

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