The prognostic value of the tumor-stroma ratio compared to tumor-infiltrating lymphocytes in triple-negative breast cancer: a review.

IF 3.1 3区医学 Q1 PATHOLOGY Virchows Archiv Pub Date : 2025-03-01 Epub Date: 2025-02-04 DOI:10.1007/s00428-025-04039-z

Layla Andour, Sophie C Hagenaars, Barbara Gregus, Anna Mária Tőkes, Zsófia Karancsi, Rob A E M Tollenaar, Judith R Kroep, Janina Kulka, Wilma E Mesker

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Abstract

Previous literature extensively explored biomarkers to personalize treatment for breast cancer patients. The clinical need is especially high in patients with triple-negative breast cancer (TNBC) due to its aggressive nature and limited treatment modalities. This review aims to evaluate the value of tumor-infiltrating lymphocytes (TILs) and tumor-stroma ratio (TSR) as prognostic biomarkers in TNBC patients and assess their clinical potential. A literature search was conducted in PubMed, Embase, Emcare, Web of Science, and Cochrane Library. Papers comparing survival outcomes of TNBC patients with low/high or negative/positive TSR and immune cells were included. The most frequently mentioned subgroups of TILs were selected and reported in this review. Data from 43 articles on TILs and eight articles on TSR were included. Among TNBC patients, high CD8 expression was generally associated with better survival. Notable, the poor survival outcomes were related to high intra-tumoral PD-L1 expression, whereas high stromal PD-L1 expression more often was correlated with favorable outcomes. For the TSR, a high amount of stroma in the primary tumor of TNBC patients was consistently associated with worse survival. This review highlights that a high number of CD8-positive T-cells is a promising prognostic factor for TNBC patients. PD-L1 expression analyzed for intra-tumoral and stromal expression separately reports strong but contrasting information. Finally, the TSR shows potential to be an important prognostic marker, especially for TNBC patients. Utilizing both biomarkers, either on itself or combined, could enhance clinical decision-making and personalization of treatment.

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肿瘤间质比与肿瘤浸润淋巴细胞在三阴性乳腺癌中的预后价值：综述

以往的文献广泛探讨了生物标志物对乳腺癌患者的个性化治疗。由于三阴性乳腺癌（TNBC）的侵袭性和有限的治疗方式，临床需求尤其高。本文旨在评估肿瘤浸润淋巴细胞（til）和肿瘤基质比（TSR）作为TNBC患者预后生物标志物的价值，并评估其临床潜力。在PubMed、Embase、Emcare、Web of Science和Cochrane Library进行文献检索。比较TSR低/高或TSR阴性/阳性和免疫细胞的TNBC患者生存结局的论文被纳入。本综述选择并报道了最常被提及的TILs亚组。纳入了43篇关于TILs的文章和8篇关于TSR的文章。在TNBC患者中，高CD8表达通常与更好的生存率相关。值得注意的是，较差的生存结果与肿瘤内PD-L1的高表达有关，而间质PD-L1的高表达更多地与良好的预后相关。对于TSR， TNBC患者原发肿瘤中大量间质始终与较差的生存率相关。这篇综述强调，大量cd8阳性t细胞是TNBC患者预后的一个有希望的因素。PD-L1在肿瘤内和间质表达的分析分别报告了强有力但有差异的信息。最后，TSR显示出作为重要预后指标的潜力，特别是对于TNBC患者。利用这两种生物标志物，无论是单独使用还是联合使用，都可以提高临床决策和个性化治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Virchows Archiv 医学-病理学

CiteScore

7.40

自引率

2.90%

发文量

204

审稿时长

4-8 weeks

期刊介绍： Manuscripts of original studies reinforcing the evidence base of modern diagnostic pathology, using immunocytochemical, molecular and ultrastructural techniques, will be welcomed. In addition, papers on critical evaluation of diagnostic criteria but also broadsheets and guidelines with a solid evidence base will be considered. Consideration will also be given to reports of work in other fields relevant to the understanding of human pathology as well as manuscripts on the application of new methods and techniques in pathology. Submission of purely experimental articles is discouraged but manuscripts on experimental work applicable to diagnostic pathology are welcomed. Biomarker studies are welcomed but need to abide by strict rules (e.g. REMARK) of adequate sample size and relevant marker choice. Single marker studies on limited patient series without validated application will as a rule not be considered. Case reports will only be considered when they provide substantial new information with an impact on understanding disease or diagnostic practice.