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Combining the tumor-stroma ratio with tumor-infiltrating lymphocytes improves the prediction of pathological complete response in breast cancer patients

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Abstract

Purpose

The tumor-stroma ratio (TSR) is a common histological parameter that measures stromal abundance and is prognostic in breast cancer (BC). However, more evidence is needed on the predictive value of the TSR for the pathological complete response (pCR) to neoadjuvant chemotherapy (NAC). The purpose of this study was to determine the importance of the TSR in predicting pCR in NAC settings.

Method

We evaluated the TSR on pretreatment biopsies of 912 BC patients from four independent Chinese hospitals and investigated the potential value of the TSR for predicting pCR. Meanwhile, stromal tumor-infiltrating lymphocytes (sTILs) were assessed, and we evaluated the predictive value of the combination of sTILs and TSR (TSRILs).

Results

Patients with low stroma showed a higher pCR rate than those with high stroma among the four independent hospitals, and in multivariate analysis, the TSR was proven to be an independent predictor for pCR to NAC with an odds ratio of 1.945 (95% CI 1.230–3.075, P = 0.004). Moreover, we found that TSRILs could improve the area under the curve (AUC) for predicting pCR from 0.750 to 0.785 (P = 0.039); especially in HER2-negative BCs, the inclusion of TSRILs increased the AUC from 0.801 to 0.835 in the discovery dataset (P = 0.048) and 0.734 to 0.801 in the validation dataset (P = 0.003).

Conclusion

TSR and sTILs can be easily measured in pathological routines and provide predictive information without additional cost; with more evidence from clinical trials, TSRILs could be a candidate to better stratify patients in NAC settings.

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Data availability

The data used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The study was supported by the 1·3·5 project for disciplines of excellence (ZYGD18012) and the Technological Innovation Project of Chengdu New Industrial Technology Research Institute (2017-CY02–00026-GX).

Author information

Author notes

  1. Fengling Li and Hong Chen have equally contributed to this work.

Authors and Affiliations

  1. Department of Pathology, West China Hospital, Sichuan University, Chengdu, China

    Fengling Li, Xunxi Lu, Yani Wei & Hong Bu

  2. Institute of Clinical Pathology, West China Hospital, Sichuan University, Chengdu, China

    Fengling Li, Hong Chen, Xunxi Lu, Yani Wei & Hong Bu

  3. Key Laboratory of Transplant Engineering and Immunology of the National Health Commission, West China Hospital, Sichuan University, Chengdu, China

    Hong Chen

  4. Department of Pathology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China

    Yuanyuan Zhao

  5. Department of Pathology, Sichuan Provincial People’s Hospital, Chengdu, China

    Jing Fu

  6. Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China

    Xiuli Xiao

Authors
  1. Fengling Li
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Contributions

FL, HC, and HB designed this study. YW, YZ, JF, XX, and FL contributed to the patient recruitment from four hospitals. XL and FL performed the evaluation of pathological parameters. FL and HC analyzed the data and wrote the draft. HB and HC edited the draft.

Corresponding author

Correspondence to Hong Bu.

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Conflict of interest

The authors declare no competing interests.

Ethical approval

Our study was approved by the ethical committee of West China Hospital, Sichuan University (No.764 in 2021), and abided with the Declaration of Helsinki before using tissue samples for scientific researches purpose only. The written informed consent was waived by the ethical committee for this retrospective study.

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Li, F., Chen, H., Lu, X. et al. Combining the tumor-stroma ratio with tumor-infiltrating lymphocytes improves the prediction of pathological complete response in breast cancer patients. Breast Cancer Res Treat 202, 173–183 (2023). https://doi.org/10.1007/s10549-023-07026-7

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  • DOI: https://doi.org/10.1007/s10549-023-07026-7

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