title: The relationship between the systemic inflammatory response, tumour proliferative activity, T-lymphocytic and macrophage infiltration, microvessel density and survival in patients with primary operable breast cancer.
abstract: The significance of the inter-relationship between tumour and host local/systemic inflammatory responses in primary operable invasive breast cancer is limited. The inter-relationship between the systemic inflammatory response (pre-operative white cell count, C-reactive protein and albumin concentrations), standard clinicopathological factors, tumour T-lymphocytic (CD4+ and CD8+) and macrophage (CD68+) infiltration, proliferative (Ki-67) index and microvessel density (CD34+) was examined using immunohistochemistry and slide-counting techniques, and their prognostic values were examined in 168 patients with potentially curative resection of early-stage invasive breast cancer. Increased tumour grade and proliferative activity were associated with greater tumour T-lymphocyte (P<0.05) and macrophage (P<0.05) infiltration and microvessel density (P<0.01). The median follow-up of survivors was 72 months. During this period, 31 patients died; 18 died of their cancer. On univariate analysis, increased lymph-node involvement (P<0.01), negative hormonal receptor (P<0.10), lower albumin concentrations (P<0.01), increased tumour proliferation (P<0.05), increased tumour microvessel density (P<0.05), the extent of locoregional control (P<0.0001) and limited systemic treatment (P<or=0.01) were associated with cancer-specific survival. On multivariate analysis of these significant covariates, albumin (HR 4.77, 95% CI 1.35-16.85, P=0.015), locoregional treatment (HR 3.64, 95% CI 1.04-12.72, P=0.043) and systemic treatment (HR 2.29, 95% CI 1.23-4.27, P=0.009) were significant independent predictors of cancer-specific survival. Among tumour-based inflammatory factors, only tumour microvessel density (P<0.05) was independently associated with poorer cancer-specific survival. The host inflammatory responses are closely associated with poor tumour differentiation, proliferation and malignant disease progression in breast cancer.
authors.affiliation: University Department of Surgery, University of Glasgow - Faculty of Medicine, Royal and Western Infirmaries, Glasgow G31 2ER, UK.
authors.forename: A M Al
authors.initials: AM
authors.lastname: Murri
authors.forename: M
authors.initials: M
authors.lastname: Hilmy
authors.forename: J
authors.initials: J
authors.lastname: Bell
authors.forename: C
authors.initials: C
authors.lastname: Wilson
authors.forename: A-M
authors.initials: AM
authors.lastname: McNicol
authors.forename: A
authors.initials: A
authors.lastname: Lannigan
authors.forename: J C
authors.initials: JC
authors.lastname: Doughty
authors.forename: D C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D001808:Blood Vessels / Q000254:growth & development*; D001943:Breast Neoplasms / Q000098:blood supply / Q000276:immunology / Q000473:pathology* / Q000601:surgery; D049109:Cell Proliferation; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008264:Macrophages / Q000276:immunology*; D009361:Neoplasm Invasiveness; D015996:Survival Rate; D013601:T-Lymphocytes / Q000276:immunology*
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