Abstract
There is strong evidence that the host’s cellular immune response is linked to tumor progression, however its impact on patient outcome in breast cancer is poorly understood. The purpose of this study is to define tumor immune subtypes, focusing on cellular immune responses and investigate their prognostic effect in breast cancer patients. Our training (n = 440) and validation cohort (n = 382) consisted of all early breast cancer patients primarily treated with surgery in our center between 1985 and 1996. Tumor tissue sections were immunohistochemically stained for CD8 (CTL) and PEN5 (NK cells). Tumor expression of classical and non-classical human leukocyte antigen class I, and tumor-infiltrating Tregs were previously determined. Tumor immune subtypes were constructed based on quantification of these markers and biological rationale. High, intermediate, and low immune susceptible tumor immune subtypes were found, respectively, in 16, 63, and 20 % of patients in the training cohort and 16, 71, and 13 % in the validation cohort. The subtypes showed to be statistically significant prognostic in multivariate analyses for relapse free period (RFP) [p < 0.0001, intermediate versus high: hazard ratio (HR) 1.95; low versus high HR 2.98] and relative survival (RS) (p = 0.006, intermediate versus high HR 3.84; low versus high: HR 4.26). Validation of these outcome analyses confirmed the independent prognostic associations: RFP (p = 0.025) and RS (p = 0.040). The tumor immune subtypes that we present represent a prognostic profile with solid underlying biological rationale and with high discriminative power confirmed in an independent validation cohort. Our results emphasize the importance of tumor immune surveillance in the control of tumor development and, therefore, in determining patient prognosis. Tumor immune subtype profiling is promising for prognosis prediction and the achievement of tailored treatment for breast cancer patients.
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Abbreviations
- CTL:
-
Cytotoxic T-cells
- NK Cells:
-
Natural killer cells
- Treg:
-
Regulatory T-cells
- HLA:
-
Human leukocyte antigen
- HER2:
-
Human epidermal growth factor receptor 2
- ER:
-
Estrogen receptor
- PR:
-
Progesterone receptor
- TAA:
-
Tumor associated antigens
- HR:
-
Hazard ratio
- 95 % CI:
-
95 % confidence interval
- RS:
-
Relative survival
- RFP:
-
Relapse free period
- RR:
-
Relative risk
- TNM stage:
-
Tumor, node, metastasis stage
- uPA:
-
Urokinases plasminogen activator
- PAI-1:
-
Plasminogen activator inhibitor-1
References
Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55:74–108
Goldhirsch A, Wood WC, Gelber RD et al (2007) Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol 18:1133–1144
Zitvogel L, Tesniere A, Kroemer G (2006) Cancer despite immunosurveillance: immunoselection and immunosubversion. Nat Rev Immunol 6:715–727
Dunn GP, Old LJ, Schreiber RD (2004) The three Es of cancer immunoediting. Annu Rev Immunol 22:329–360
Algarra I, Garcia-Lora A, Cabrera T et al (2004) The selection of tumor variants with altered expression of classical and nonclassical MHC class I molecules: implications for tumor immune escape. Cancer Immunol Immunother 53:904–910
Wischhusen J, Waschbisch A, Wiendl H (2007) Immune-refractory cancers and their little helpers: an extended role for immunetolerogenic MHC molecules HLA-G and HLA-E? Semin Cancer Biol 17:459–468
Khong HT, Restifo NP (2002) Natural selection of tumor variants in the generation of “tumor escape” phenotypes. Nat Immunol 3:999–1005
Marin R, Ruiz-Cabello F, Pedrinaci S et al (2003) Analysis of HLA-E expression in human tumors. Immunogenetics 54:767–775
Cerwenka A, Baron JL, Lanier LL (2001) Ectopic expression of retinoic acid early inducible-1 gene (RAE-1) permits natural killer cell-mediated rejection of a MHC class I-bearing tumor in vivo. Proc Natl Acad Sci USA 98:11521–11526
Liu F, Lang R, Zhao J et al (2011) CD8(+) cytotoxic T cell and FOXP3(+) regulatory T cell infiltration in relation to breast cancer survival and molecular subtypes. Breast Cancer Res Treat 130(2):645–655
Mahmoud SM, Paish EC, Powe DG et al (2011) Tumor-infiltrating CD8+ lymphocytes predict clinical outcome in breast cancer. J Clin Oncol 29:1949–1955
de Kruijf EM, Sajet A, van Nes JG et al (2010) HLA-E and HLA-G expression in classical HLA class I-negative tumors is of prognostic value for clinical outcome of early breast cancer patients. J Immunol 185:7452–7459
Kleinberg L, Florenes VA, Skrede M et al (2006) Expression of HLA-G in malignant mesothelioma and clinically aggressive breast carcinoma. Virchows Arch 449:31–39
Lefebvre S, Antoine M, Uzan S et al (2002) Specific activation of the non-classical class I histocompatibility HLA-G antigen and expression of the ILT2 inhibitory receptor in human breast cancer. J Pathol 196:266–274
Bates GJ, Fox SB, Han C et al (2006) Quantification of regulatory T cells enables the identification of high-risk breast cancer patients and those at risk of late relapse. J Clin Oncol 24:5373–5380
de Kruijf EM, van Nes JG, Sajet A et al (2010) The predictive value of HLA class I tumor cell expression and presence of intratumoral Tregs for chemotherapy in patients with early breast cancer. Clin Cancer Res 16:1272–1280
Ladoire S, Arnould L, Apetoh L et al (2008) Pathologic complete response to neoadjuvant chemotherapy of breast carcinoma is associated with the disappearance of tumor-infiltrating foxp3+ regulatory T cells. Clin Cancer Res 14:2413–2420
Galon J, Costes A, Sanchez-Cabo F et al (2006) Type, density, and location of immune cells within human colorectal tumors predict clinical outcome. Science 313:1960–1964
van Nes JG, de Kruijf EM, Faratian D et al (2010) COX2 expression in prognosis and in prediction to endocrine therapy in early breast cancer patients. Breast Cancer Res Treat 125(3):671–685
Ghiringhelli F, Menard C, Terme M et al (2005) CD4+ CD25+ regulatory T cells inhibit natural killer cell functions in a transforming growth factor-beta-dependent manner. J Exp Med 202:1075–1085
DeNardo DG, Brennan DJ, Rexhepaj E et al (2011) Leukocyte complexity predicts breast cancer survival and functionally regulates response to chemotherapy. Cancer Discov 1:54–67
Matkowski R, Gisterek I, Halon A et al (2009) The prognostic role of tumor-infiltrating CD4 and CD8 T lymphocytes in breast cancer. Anticancer Res 29:2445–2451
Gobert M, Treilleux I, Driss-Vermare N et al (2009) Regulatory T cells recruited through CCL22/CCR4 are selectively activated in lymphoid infiltrates surrounding primary breast tumors and lead to an adverse clinical outcome. Cancer Res 69:2000–2009
Madjd Z, Spendlove I, Pinder SE et al (2005) Total loss of MHC class I is an independent indicator of good prognosis in breast cancer. Int J Cancer 117:248–255
Gudmundsdottir I, Gunnlaugur JJ, Sigurdsson H et al (2000) Altered expression of HLA class I antigens in breast cancer: association with prognosis. Int J Cancer 89:500–505
Redondo M, Garcia J, Villar E et al (2003) Major histocompatibility complex status in breast carcinogenesis and relationship to apoptosis. Hum Pathol 34:1283–1289
Menon AG, Janssen-Van Rhijn CM, Morreau H et al (2004) Immune system and prognosis in colorectal cancer: a detailed immunohistochemical analysis. Lab Invest 84:493–501
Harris L, Fritsche H, Mennel R et al (2007) American Society of Clinical Oncology 2007 update of recommendations for the use of tumor markers in breast cancer. J Clin Oncol 25:5287–5312
Michiels S, Koscielny S, Hill C (2005) Prediction of cancer outcome with microarrays: a multiple random validation strategy. Lancet 365:488–492
van de Vijver MJ, He YD, van’t Veer LJ et al (2002) A gene-expression signature as a predictor of survival in breast cancer. N Engl J Med 347:1999–2009
Sotiriou C, Pusztai L (2009) Gene-expression signatures in breast cancer. N Engl J Med 360:790–800
McShane LM, Altman DG, Sauerbrei W et al (2006) REporting recommendations for tumor MARKer prognostic studies (REMARK). Breast Cancer Res Treat 100:229–235
Acknowledgments
Research support: Dutch Cancer Society (KWF 2007-3968). Furthermore, we would like to thank Johanna G.H. van Nes for her help with the database, Anita Sajet for her help with scoring the TMA and the colleagues at the research laboratory of the surgery department at the LUMC for their help and advice.
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The authors declare that they have no competing interests.
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de Kruijf, E.M., Engels, C.C., van de Water, W. et al. Tumor immune subtypes distinguish tumor subclasses with clinical implications in breast cancer patients. Breast Cancer Res Treat 142, 355–364 (2013). https://doi.org/10.1007/s10549-013-2752-2
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DOI: https://doi.org/10.1007/s10549-013-2752-2