The possible role of stromal cell stimulation in worsening the prognosis of a subset of patients with breast cancer.
This review examines the evidence that a subset of patients with breast cancer have tumors that are stimulated to grow by host cells in the tumor stroma. The search for such a minority group was prompted by the following observations. Adjuvant chemotherapy which is immunosuppressive improves disease-free interval and survival, whereas non-specific immunostimulation worsens the prognosis. Intrinsic immune reactivity is associated with a poor prognosis. A subset of tumors with a bad prognosis has anaplastic cells, dermal lymphatic invasion and a moderate to intense lymphoplasmacytic stromal infiltrate. Evidence is reviewed that adjuvant chemotherapy may be beneficial by virtue of its immunosuppressive effects in addition to tumor kill of minimal residual disease.
Stewart
T H
TH
Department of Medicine, Ottawa General Hospital, Ontario, Canada.
Tsai
S C
SC
D001500:BCG Vaccine / Q000009:adverse effects; D015982:Bias; D001943:Breast Neoplasms / Q000276:immunology* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology; D007165:Immunosuppression Therapy; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology*; D011379:Prognosis
D001500:BCG Vaccine