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高 TIL(肿瘤浸润淋巴细胞)与接受新辅助 KEYNOTE-522 化疗免疫治疗的三阴性乳腺癌病理完全缓解显著相关

英文原题:High tumor infiltrating lymphocytes are significantly associated with pathological complete response in triple negative breast cancer treated with neoadjuvant KEYNOTE-522 chemoimmunotherapy.

查看英文原题

High tumor infiltrating lymphocytes are significantly associated with pathological complete response in triple negative breast cancer treated with neoadjuvant KEYNOTE-522 chemoimmunotherapy.

PubMed 2024/01/30(内容时间) Breast Cancer Res Treat Q2 · IF 3.3(JCR 2025)

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研究概要

我们的真实世界数据表明,高 TIL 与 K522 方案中的 pCR 率显著相关,并可能作为选择最佳治疗的生物标志物。我们研究中 48.4% 的 pCR 率低于 K522 中报告的结果,可能由于我们研究规模较小;然而,这也可能表明真实世界数据与临床试验结果之间存在差异。需要更大规模的研究来进一步探讨免疫细胞在 TNBC 对 K522 及其他治疗方案应答中的作用。

研究思路结论见上方概要

对于局部晚期三阴性乳腺癌(TNBC)患者,标准治疗是给予KEYNOTE-522(K522)方案,包括在新辅助治疗中给予化疗和免疫治疗(pembrolizumab)。接受K522方案的患者比接受标准化疗的患者更可能达到病理学完全缓解(pCR)。研究表明,pCR是长期无病生存期的强预测因子。然而,预测K522方案pCR的因素尚未被充分了解,需要在真实世界人群中进一步研究。

我们评估了76例在本机构接受K522方案治疗的患者。29例治疗前活检切片可用于病理复核。在这29例中评估了核分级、Nottingham组织学分级、Ki-67、淋巴血管侵犯和TIL(肿瘤浸润淋巴细胞)。对于治疗前活检无可用切片进行复核的病例,这些变量从可获得的病理报告中提取。此外,从全部76例患者的病历中提取了活检时的临床分期、种族和BMI。采用二元逻辑回归模型将这些变量与pCR进行相关性分析。

目前,76例患者中已有64例在我们机构完成K522后接受了手术,其中31例(48.4%)达到pCR。在单变量分析中,仅TIL与pCR显著相关(p = 0.014),这一发现在多变量分析中也得到证实,而其他变量包括年龄、种族、核分级、Nottingham分级、Ki-67、淋巴血管侵犯、BMI、治疗前肿瘤大小和淋巴结状态均与pCR无关(p > 0.1)。

展开英文摘要原文

We evaluated 76 patients who were treated with the K522 regimen at our institution. Twenty-nine pre-treatment biopsy slides were available for pathology review. Nuclear grade, Nottingham histologic grade, Ki-67, lymphovascular invasion, and tumor infiltrating lymphocytes (TIL) were evaluated in these 29 cases. For the cases that did not have available slides for review from pre-treatment biopsies, these variables were retrieved from available pathology reports. In addition, clinical staging, race, and BMI at the time of biopsy were retrieved from all 76 patients' charts. Binary logistic regression models were used to correlate these variables with pCR.

At the current time, 64 of 76 patients have undergone surgery at our institution following completion of K522 and 31 (48.4%) of these achieved pCR. In univariate analysis, only TIL was significantly associated with pCR (p = 0.014) and this finding was also confirmed in multivariate analysis, whereas other variables including age, race, nuclear grade, Nottingham grade, Ki-67, lymphovascular invasion, BMI, pre-treatment tumor size, and lymph node status were not associated with pCR (p > 0.1).

Our real-world data demonstrates high TIL is significantly associated with pCR rate in the K522 regimen and may potentially serve as a biomarker to select optimal treatment. The pCR rate of 48.4% in our study is lower than that reported in K522, potentially due to the smaller size of our study; however, this may also indicate differences between real-world data and clinical trial results. Larger studies are warranted to further investigate the role of immune cells in TNBC response to K522 and other treatment regimens.

论文信息

作者
Wood SJ、Gao Y、Lee JH、Chen J、Wang Q、Meisel JL、Li X
第一作者单位
Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA.United States
通讯作者单位
Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA. xli40@emory.edu.United States
期刊
Breast cancer research and treatment2024 May
原文标识
PubMed 38286889 · DOI 10.1007/s10549-023-07233-2