摘要
目的探讨瘤巢肿瘤浸润淋巴细胞(ITILs)、间质肿瘤浸润淋巴细胞(STILs)和整体肿瘤浸润淋巴细胞(TILs)水平对三阴性乳腺癌(TNBC)病人预后的影响。方法收集2015年1月—2022年12月在本院接受手术治疗的187例女性TNBC病人的临床资料。采用苏木精-伊红染色评估各部位TILs百分比,Kaplan-Meier生存曲线分析TNBC组织各部位TILs高低对病人生存预后的影响,Cox回归模型分析影响TNBC病人生存的独立危险因素。结果临床分期为Ⅰ~Ⅱ期、阳性淋巴结数目为0~3个的TNBC病人癌组织中ITILs、STILs和TILs的高表达率分别显著高于临床分期为Ⅲ期、阳性淋巴结数目≥4个的病人(χ^(2)=8.749~28.970,P<0.05),ITILs、STILs、TILs表达水平与病人的年龄、绝经状态、手术方式、肿瘤部位、肿瘤大小等无关(P>0.05)。与低表达组比较,ITILs、STILs、TILs高表达组病人的4年总生存时间(OS)和无进展生存时间(DFS)明显延长,差异均有统计学意义(χ^(2)=4.959~21.078,P<0.05)。单因素分析显示,临床分期、阳性淋巴结数目、ITILs、STILs、TILs是影响TNBC病人OS和DFS的预后因素(β=-3.474~2.407,HR(95%CI)=0.031(0.004~2.262)~11.097(0.249~57.311),P<0.05)。多因素回归分析显示,阳性淋巴结数目是影响TNBC病人OS和DFS的独立危险因素(β=1.756、1.418,HR(95%CI)=5.787(1.786~42.622)、4.327(1.192~17.965),P<0.05);ITILs、STILs是TNBC病人术后OS和DFS的独立保护因素(β=-5.167~-1.242,HR(95%CI)=0.006(0~0.128)~0.289(0.086~0.973),P<0.05)。结论ITILs、STILs是TNBC病人生存的独立保护因素。
Objective To investigate the impact of the levels of intratumoral tumor-infiltrating lymphocytes(ITILs),stromal tumor-infiltrating lymphocytes(STILs),and global tumor-infiltrating lymphocytes(TILs)on the prognosis of patients with triple-negative breast cancer(TNBC).Methods Clinical data were collected from 187 female TNBC patients who underwent surgical treatment in our hospital from January 2015 to December 2022.Hematoxylin-eosin staining was used to measure the percentage of TILs at each site;the Kaplan-Meier survival curve was used to analyze the impact of the high or low infiltration levels of TILs at different sites of TNBC tissue on the survival prognosis of patients;the Cox regression model was used to analyze the independent risk factors for the survival of TNBC patients.Results The high expression rates of ITILs,STILs,and TILs in the cancerous tissue of TNBC patients with clinical stage Ⅰ-Ⅱ disease and 0-3 positive lymph nodes were significantly higher than those in the cancerous tissue of TNBC patients with clinical stage Ⅲ disease and≥4 positive lymph nodes(χ^(2)=8.749-28.970,P<0.05).The expression levels of ITILs,STILs,and TILs were not associated with age,menopausal status,surgical procedure,tumor location,and tumor size(P>0.05).Compared with the low-expression group,the high-expression group in terms of ITILs,STILs,and TILs had a significantly higher 4-year overall survival(OS)rate and a significantly longer disease-free survival(DFS)(χ^(2)=4.959-21.078,P<0.05).The univariate analysis showed that clinical stage,the number of positive lymph nodes,ITILs,STILs,and TILs were influencing factors for the OS and DFS of TNBC patients(β=-3.474 to 2.407,HR=0.031-11.097,95%CI=0.004-2.262 to 0.249-57.311,P<0.05).The multivariate regression analysis showed that the number of positive lymph nodes was an independent risk factor for the OS and DFS of TNBC patients(β=1.756 and 1.418,HR=5.787 and 4.327,95%CI=1.786-42.622 to 1.192-17.965,P<0.05),while ITILs and STILs were independent protective factors for the postoperative OS and DFS of TNBC patients(β=-5.167 to-1.242,HR=0.006-0.289,95%CI=0-0.128 to 0.086-0.973,P<0.05).Conclusion ITILs and STILs are independent protective factors for the survival of TNBC patients.
作者
李欣
宋玉华
孟令军
王琪
梁洪陆
LI Xin;SONG Yuhua;MENG Lingjun;WANG Qi;LIANG Honglu(Department of Radiotherapy,Qilu Hospital of Shandong University Dezhou Hospital,Dezhou 253000,China)
出处
《青岛大学学报(医学版)》
2025年第5期715-721,共7页
Journal of Qingdao University(Medical Sciences)
基金
中国青岛市博士后应用研究基金项目(RZ2-100001380)。
关键词
三阴性乳腺癌
肿瘤浸润
淋巴细胞
预后
triple negative breast neoplasms
neoplasm invasiveness
lymphocytes
prognosis
