title: Tumor cell expression of HLA-DM associates with a Th1 profile and predicts improved survival in breast carcinoma patients.
abstract: Studies aimed at elucidating the immunological and prognostic significance of HLA-DR expression on breast carcinoma cells have yielded contradictory results. To expand on previous studies, we have investigated the associations of tumor cell expression of HLA-DR and its related co-chaperones, invariant chain (Ii) and HLA-DM, with infiltrating inflammatory cells, in situ cytokine mRNA levels and prognosis and outcome in 112 breast carcinoma patients with a median follow-up of 59 months. While the majority of HLA-DR+ tumors co-express Ii, only a minority express HLA-DM. Tumor cell expression of HLA-DR and co-chaperones positively associated with both infiltrating CD4+ and CD8+ T-cell subsets (P < 0.01). Expression of HLA-DR and Ii associated with decreased estrogen receptor alpha levels and younger age at diagnosis, suggesting a role for hormones in the control of HLA class II expression in breast carcinoma. Patients with DR+Ii+DM- tumors had markedly decreased recurrence-free and disease-specific survival as compared with patients with DR+Ii+DM+ tumors (P < 0.05) and HLA-DR/co-chaperone expression was an independent predictor of survival by multivariate Cox regression analysis, controlling for standard prognostic indicators. Tumors that co-express HLA-DR, Ii and HLA-DM have increased levels of IFN-gamma, IL-2 and IL-12 mRNA, suggesting improved survival of patients with DR+Ii+DM+ tumors may be attributable to Th1-dominated immunity. We conclude that expression of determinants of the immune response by tumor cells may influence breast tumor progression and patient outcome.
authors.affiliation: Division of Basic Medical Sciences, Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Oldford
authors.forename: J Desmond
authors.initials: JD
authors.lastname: Robb
authors.forename: Dianne
authors.initials: D
authors.lastname: Codner
authors.forename: Veeresh
authors.initials: V
authors.lastname: Gadag
authors.forename: Peter H
authors.initials: PH
authors.lastname: Watson
authors.forename: Sheila
authors.initials: S
authors.lastname: Drover
mesh_terms: D001943:Breast Neoplasms / Q000276:immunology / Q000378:metabolism*; D002277:Carcinoma / Q000276:immunology / Q000378:metabolism*; D018572:Disease-Free Survival; D005260:Female; D006681:HLA-D Antigens / Q000378:metabolism*; D006684:HLA-DR Antigens / Q000378:metabolism; D006801:Humans; D018417:Th1 Cells / Q000276:immunology*
chemical_list: D006681:HLA-D Antigens; C084245:HLA-DM antigens; D006684:HLA-DR Antigens