Abstract P2-08-31: Predictive and prognostic value of stromal tumor-infiltrating lymphocytes before and after neoadjuvant therapy in triple negative and HER2-positive breast cancer

Background: Lymphocyte predominant breast cancer subgroup, defined as ≥ 50% stromal tumor-infiltrating lymphocytes (sTILs), is associated with high pathological complete response (pCR) rate after neoadjuvant therapy (NAT) and favorable outcome. In a cohort of triple negative (TNBC) and HER2+ breast cancer (BC) patients treated with NAT, we aimed to assess the predictive and prognostic value of pre- and post-NAT sTILs and the information provided by the change in sTILs during NAT.

Materials and methods: Two-hundred and nine consecutive patients (n=80 TNBC; and n=129 HER2+) who received NAT between 2001 and 2009 in our institution were evaluated. Pre-NAT sTILs were assessed on biopsy sample (baseline) and post-NAT sTILs on surgical specimens just for non-pCR patients. sTILs level was categorized as low 0-9%, intermediate 10-49%, and high ≥50%. The change in sTILs during NAT was calculated as the absolute difference between pre- and post-NAT sTILs. We evaluated the association of pre-NAT sTILs and pCR, and the association between pre- and post-NAT sTILs, and their change with relapse-free survival (RFS).

Results: Overall pCR rate was 37.8% (31.3% for TNBC, 41.2% for ER+/HER2+BC, 42.3% for ER-/HER2+BC). In each subtype, pre-NAT low sTILs group was significantly associated with lower pCR rate. During the median follow-up period of 98 months, 44 recurrences (21.1%) were observed. For TNBC, low pre-NAT sTILs group was associated with higher recurrence risk compared with int/high sTILs (HR=4.675 [2.013-10.859], p<0.001). For only non-pCR patients, both pre- and post-NAT sTILs were significantly associated with RFS. The risk of recurrence was higher in the group with low pre-NAT sTILs (HR=5.333 [1.731-16.427], p=0.004), and the group of low post-NAT sTILs (HR=4.271 [1.498-12.173], p=0.007). Patients with the change of sTILs increase during NAT were not associated with RFS, compared with decrease or equal group (log-rank p=0.163). In multivariate analysis including both pre- and post-NAT sTILs, only pre-NAT sTILs retained significance (HR=3.844 [1.190-12.421], p=0.024). Low post-NAT sTILs group showed only a borderline significant association with shorter RFS (HR=2.836 [0.951-8.457], p=0.061), but it suggests that both pre- and post-NAT sTILs might provide independent prognostic information. In ER+/HER2+BC, low pre-NAT sTILs were associated with short RFS (p=0.036), but this association was not significant when only non-pCR patients were considered. In ER−/HER2+BC, sTILs were not significantly associated with RFS.

Conclusion: In TN and HER2+ BCs, tumors with low pre-NAT sTILs have a low likelihood to achieve a pCR (predictive marker). In TNBC, low pre-NAT sTILs were associated with higher recurrence risk. In non-pCR TNBC patients, both low pre- and post-NAT sTILs were associated with shorter RFS. These results suggest that sTILs information should be taken into account when additional post-surgery treatments are considered in non-pCR patients.

Citation Format: Ochi T, Giampaolo B, Murai M, Nozaki F, Kobayashi D, Iwamoto T, Niikura N, Suzuki K, Yamauchi H, Hayashi N. Predictive and prognostic value of stromal tumor-infiltrating lymphocytes before and after neoadjuvant therapy in triple negative and HER2-positive breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-31.

[Aperiodic analysis of EEG in children during halothane anesthesia]

The difference according to age of EEG was studied during halothane and nitrous oxide anesthesia in 33 children ranging from neonate to 14 year old, using the Lifescan EEG Monitor (Neurometrics). The EEG of 12 infants younger than 6 months showed dominant slow waves, and did not show any activation with the stimulus induced by peritoneal retraction, while EEG of older children showed the high-voltage slow wave responding to such stimulus. Some of teen-agers showed the fast wave predominant response to such stimulus, which is observed in adults. When the EEG monitor is used to examine the depth of anesthesia, we always have to consider the differences according to age, especially in children.

Perisinusoidal cells in a three-dimensional organization of the adrenal cortex in the monkey

The adrenal cortex in the macaque monkey was examined under the SEM and TEM to elucidate the surface fine structure of perisinusoidal cells in a three-dimensional organization of the cortex. Parenchymal cells in polyhedral form were arranged in acini in the zona glomerulosa, or in the laminae of closely stacked cells in the zona fasciculata and reticularis. Those acini and laminae were accompanied by sinusoids lined only with an endothelium. Endothelial cells were composed of a protruded perikaryon and a thin layer of peripheral cytoplasm in sieve plates with numerous fenestrations. The perikaryon was sometimes equipped with groups of fenestrated disc-like protrusions. Fine collagen fibrils were distributed in the perisinusoidal space, which was a continuous, slit-like lacune between the endothelial and parenchymal cells. In the perisinusoidal space or intercellular spaces among parenchymal cells were seen two types of perisinusoidal cells: the stellate interstitial cells with several spiny, or attenuated processes entangled with collagen fibrils, and the monstrous wandering cells usually associated with pseudopodia-like processes. The cytoplasm of the interstitial cells showed a structure similar to that of fibroblasts, and contained small numbers of lipid droplets. Intravenously injected chicken blood cells were phagocytized by macrophages on the sinusoidal lining. The fine cytological structure of the macrophages was almost the same as that of the wandering cells. The present findings suggest that the interstitial cells are fibroblastic in nature and belong to the vitamin-A storing cell system, and that the wandering cells are macrophages derived from hematogenous monocytes.

Strongyloides stercoralis hyperinfection: sequential changes of gastrointestinal radiology after treatment with thiabendazole

Sequential changes of gastrointestinal radiology are described in a case of Strongyloides stercoralis hyperinfection. Duodenal dilatation, reflux of barium into the biliary and pancreatic duct, and mucosal thickening of the small intestine were the striking features before treatment. Although treatment with thiabendazole led to rapid and complete clearance of rhabditiform larvae, some abnormal radiologic changes in the small intestine persisted for approximately 4 months before the mucosal pattern reverted to normal.