The METINUS Plus method for nuclei quantification in tissue microarrays of breast cancer and axillary node tissue section

CD68 and CD83 immune populations in non-metastatic axillary lymph nodes are of prognostic value for the survival and relapse of breast cancer patients

BACKGROUND

The foremost cause of death of breast cancer (BC) patients is metastasis, and the first site to which BC predominantly metastasizes is the axillary lymph node (ALN). Thus, ALN status is a key prognostic indicator at diagnosis. The immune system has an essential role in cancer progression and dissemination, so its evaluation in ALNs could have significant applications. In the present study we aimed to investigate the association of clinical-pathological and immune variables in the primary tumour and non-metastatic ALNs (ALNs^-) of a cohort of luminal A and triple-negative BC (TNBC) patients with cancer-specific survival (CSS) and time to progression (TTP).

METHODS

We analysed the differences in the variables between patients with different outcomes, created univariate and multivariate Cox regression models, validated them by bootstrapping and multiple imputation of missing data techniques, and used Kaplan-Meier survival curves for a 10-years follow-up.

RESULTS

We found some clinical-pathological variables at diagnosis (tumour diameter, TNBC molecular profile and presence of ALN metastasis), and the levels of several immune markers in the two studied sites, to be associated with worse CSS and TTP. Nevertheless, only CD68 and CD83 in ALNs^- were confirmed as independent prognostic factors for TTP.

CONCLUSIONS

The study identified the importance of macrophage and dendritic cell markers as prognostic factors of relapse for BC. We highlight the importance of studying the immune response in ALNs^-, which could be relevant to the prediction of BC patients' outcome.

Differences in the Immune Response of the Nonmetastatic Axillary Lymph Nodes between Triple-Negative and Luminal A Breast Cancer Surrogate Subtypes

Breast cancer (BC) comprises four immunohistochemical surrogate subtypes of which triple-negative breast cancer (TNBC) has the highest risk of mortality. Axillary lymph nodes (ALNs) are the regions where BC cells first establish before distant metastasis, and the presence of tumor cells in the ALN causes an immune tolerance profile that contrasts with that of the nonmetastatic ALN (ALN^-). However, few studies have compared the immune components of the ALNs^- in BC subtypes. The present study aimed to determine whether differences between immune populations in the primary tumor and ALNs^- were associated with the luminal A or TNBC subtype. We evaluated a retrospective cohort of 144 patients using paraffin-embedded biopsies. The TNBC samples tended to have a higher histologic grade and proliferation index and had higher levels of immune markers compared with luminal A in primary tumors and ALNs^-. Two methods for validating the multivariate analysis found that histologic grade, intratumoral S100 dendritic cells, and CD8 T lymphocytes and CD57 natural killer cells in the ALNs^- were factors associated with TNBC, whereas CD83 dendritic cells in the ALNs^- were associated with the luminal A subtype. In conclusion, we found that intratumoral regions and ALNs^- of TNBC contained higher concentrations of markers related to immune tolerance than luminal A. This finding partially explains the worse prognosis of patients with TNBC.

The Immune Response in Nonmetastatic Axillary Lymph Nodes Is Associated with the Presence of Axillary Metastasis and Breast Cancer Patient Outcome

Tumor cells can modify the immune response in primary tumors and in the axillary lymph nodes with metastasis (ALN⁺) in breast cancer (BC), influencing patient outcome. We investigated whether patterns of immune cells in the primary tumor and in the axillary lymph nodes without metastasis (ALN^-) differed between patients diagnosed without ALN⁺ (diagnosed-ALN^-) and with ALN⁺ (diagnosed-ALN⁺) and the implications for clinical outcome. Eleven immune markers were studied using immunohistochemistry, tissue microarray, and digital image analysis in 141 BC patient samples (75 diagnosed-ALN⁺ and 66 diagnosed-ALN^-). Two logistic regression models were derived to identify the clinical, pathologic, and immunologic variables associated with the presence of ALN⁺ at diagnosis. There are immune patterns in the ALN^- associated with the presence of ALN⁺ at diagnosis. The regression models revealed a small subgroup of diagnosed-ALN⁺ with ALN^- immune patterns that were more similar to those of the ALN^- of the diagnosed-ALN^-. This small subgroup also showed similar clinical behavior to that of the diagnosed-ALN^-. Another small subgroup of diagnosed-ALN^- with ALN^- immune patterns was found whose members were more similar to those of the ALN^- of the diagnosed-ALN⁺. This small subgroup had similar clinical behavior to the diagnosed-ALN⁺. These data suggest that the immune response present in ALN^- at diagnosis could influence the clinical outcome of BC patients.