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.
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.
Murri
A M Al
AM
University Department of Surgery, University of Glasgow - Faculty of Medicine, Royal and Western Infirmaries, Glasgow G31 2ER, UK.
Hilmy
M
M
Bell
J
J
Wilson
C
C
McNicol
A-M
AM
Lannigan
A
A
Doughty
J C
JC
McMillan
D C
DC
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*
Histopathology. 2006 May;48(6):692-701
16681685
Eur J Surg Oncol. 1995 Oct;21(5):504-9
7589594
Br J Cancer. 2000 Jan;82(2):339-47
10646886
Nutr Cancer. 2001;41(1-2):64-9
12094630
Anticancer Res. 1999 Mar-Apr;19(2B):1427-32
10365118
J Pathol. 1994 Mar;172(3):229-35
8195926
Br J Cancer. 2003 Nov 17;89(10):1906-8
14612901
Br J Surg. 2003 Feb;90(2):215-9
12555298
Clin Cancer Res. 2000 Jan;6(1):139-46
10656442
Adv Immun Cancer Ther. 1985;1:1-28
3916661
Mol Pharmacol. 2006 Nov;70(5):1812-21
16908599
Br J Cancer. 2003 Sep 15;89(6):1028-30
12966420
J Clin Oncol. 1996 Jan;14(1):85-94
8558226
Science. 2006 Sep 29;313(5795):1960-4
17008531
Nat Rev Immunol. 2004 Aug;4(8):641-8
15286730
Cancer Res. 2007 Jun 1;67(11):5064-6
17545580
Anaesthesia. 1998 Aug;53(8):789-803
9797524
J R Coll Surg Edinb. 1990 Oct;35(5):289-92
2283605
Clin Cancer Res. 1999 May;5(5):1131-7
10353748
Br J Cancer. 1996 Sep;74(5):796-801
8795584
Breast. 2003 Jun;12(3):172-8
14659323
Clin Cancer Res. 2006 Jan 15;12(2):465-72
16428488
Int J Colorectal Dis. 2007 Aug;22(8):881-6
17245566
Anticancer Res. 1990 Mar-Apr;10(2A):343-51
2346307
Oncol Rep. 2005 Aug;14(2):425-31
16012726
Cancer Res. 1996 Oct 15;56(20):4625-9
8840975
Br J Cancer. 2005 Feb 28;92(4):651-4
15700032
Cancer. 2003 Mar 1;97(5):1321-31
12599241
Endocr Pathol. 1997 Spring;8(1):29-36
12114669
Breast Cancer Res. 2004;6(4):R372-4
15217504
J Mammary Gland Biol Neoplasia. 2006 Jan;11(1):63-73
16900390
J Cancer Res Clin Oncol. 1991;117(2):163-7
1826109
JPEN J Parenter Enteral Nutr. 2003 Jan-Feb;27(1):10-5
12549592
Arch Immunol Ther Exp (Warsz). 2001;49 Suppl 2:S75-81
11665751
Br J Cancer. 2006 Jan 30;94(2):227-30
16404432
Acta Oncol. 1991;30(7):797-802
1764269
Clin Exp Metastasis. 1993 Jul;11(4):295-305
8319378
Breast Cancer Res. 2003;5(2):83-8
12631386
Nature. 2002 Dec 19-26;420(6917):860-7
12490959
Anticancer Res. 1998 Sep-Oct;18(5B):3767-70
9854492
Cancer. 1993 Jun 15;71(12):3926-31
8508358
Br J Cancer. 2007 Mar 26;96(6):891-5
17375036
Cancer Res. 2004 May 1;64(9):2941-55
15126324
Br J Cancer. 2004 Aug 2;91(3):541-3
15266325
Endocr Relat Cancer. 2005 Jul;12 Suppl 1:S37-46
16113098
J Cell Physiol. 2000 Mar;182(3):311-22
10653597
J Clin Epidemiol. 1997 Jun;50(6):693-703
9250267