Clinical Significance Of Tumor Infiltrating Lymphocytes Changes After Core Needle Biopsy In Breast Cancer

Objective: The aim of this study is to investigate the changes of TILs between core needle biopsy(CNB)and surgery removed sample(SRS)in breast cancer patients and its influencing factors.We further analyze the prognostic significance of TILs and TILs changes.Materials and Methods: Retrospectively analyze patients who were diagnosed with invasive breast cancer by CNB and received further surgery without neoadjuvant therapy in Shanghai Ruijin Hospital from January 2009 to December 2011.Patients with CNB and SRS sections available for TILs evaluation were enrolled in this study.Collect the basic characteristics of patients and evaluate stromal TILs(s TILs)of CNB and SRS respectively.High TILs was defined as with TILs?10%.Lymphocyte predominant breast cancer(LPBC)was defined as with TILs ?50%.Non-lymphocyte predominant cancer(n LPBC)was defined as with TILs<50%.Change of TILs(?TILs)was defined as SRS-TILs minus CNB-TILs.Patients were classified into n LPBC-n LPBC,n LPBC-LPBC,LPBC-LPBC,LPBC-n LPBC groups according to the change pattern of LPBC from CNB to SRS.Use Spearman test and Logisitc regression test to analyze the influencing factors of ?TILs.The influence of TILs and?TILs on breast cancer free interval(BCFI)and overall survival(OS)was analyzed by Log rank test and Cox proportional hazads model.Results: 255 patients were enrolled in this study.The median values of CNB-TILs and SRS-TILs were 5%(1%,20%)and 10%(5%,35%).The mean values were 13.8%±19.0% and 22.3%±23.4%.The value of SRS-TILs was significant higher than that of CNB-TILs,P<0.001.Univariate analysis showed that age(P=0.005),ER status(P<0.001),PR status(P=0.044),Ki67 value(P=0.020),molecular subtype(P=0.008),surgery time interval(P=0.003)was associated with ?TILs.Multivariate analysis showed age<60(OR=2.05,95%CI 1.19-3.54,P=0.009),ER negativity(OR=11.68,95%CI 2.99-45.60,P<0.001),Ki67?20%(OR=2.16,95%CI 1.13-4.10,P=0.020),surgery time interval?4 days(OR=2.61,95%CI 1.51-4.50,P=0.001)were independent factors influencing ?TILs.The estimated 5-year BCFI was 100% and86.5% of CNB-LPBC and CNB-n LPBC(P=0.044).There was no significant difference of BCFI between SRS-LPBC and SRS-n LPBC(P=0.333),CNB-High TILs and CNB-Low TILs(P=0.506)or SRS-High TILs and SRS-Low TILs(P=0.612).Patient number of n LPBC-n LPBC,n LPBC-LPBC,LPBC-LPBC and LPBC-n LPBC patterns were 197,33,23 and 25,respectively.The estimated 5-year BCFI of each pattern was 89.1%,71.4%,100% and 100%,respectively.The BCFI of n LPBC-LPBC patients was significantly lower than that of n LPBC-n LPBC(P=0.007)and LPBC-LPBC(P=0.005).Mutltivariate analysis showed that n LPBC-LPBC was an independent prognostic factor of BCFI(HR=2.57,95%CI 1.16-5.73,P=0.020).The influence of TILs and ?TILs on OS was not significant.Conclusion: TILs was significantly higher in SRS than in CNB.Age<60,ER negativity,Ki67?20% and surgery time interval?4 days were independently associated with higher ?TILs.CNB-LPBC patients had good prognosis.Patients changed from n LPBC to LPBC after CNB had the worst prognosis.