title: Predictive and prognostic factors in locally advanced breast cancer: effect of intratumoral FOXP3+ Tregs.
abstract: This study aimed to investigate the prognostic and predictive effect of FOXP3+ Tregs together with clinicopathologic factors in locally advanced breast cancer (LABC) patients. The medical records of 101 LABC patients who received neoadjuvant chemotherapy (NAC) between 2005 and 2012 were evaluated retrospectively. The density of intratumoral FOXP3+ lymphocytes in paraffin-embedded tissues was assessed by immunohistochemical analyses in appropriate cases. The relationship with clinicopathologic features, prognosis and chemotherapy response was investigated. HR(-) and HER2(+) tumors tended to have higher pre-chemotherapy Tregs than HR(+) tumors, and significantly higher pathologic complete response (PCR) rates were observed in these patients. Treg decline after NAC was associated with better pathological response rates. Lower intratumoral infiltration of FOXP3+ Tregs after NAC (<3.4/HPF) was significantly associated with higher PCR rates for breast, and close to the significance limit for total (or both for breast and axillary) PCR rates (PCR for breast: 25 vs. 2.9 % for low vs. high Treg, p = 0.001; PCR for breast + axillary tissue: 13.9 vs. 0 %, p = 0.05). Despite better PCR rates, patients with high intratumoral Treg infiltrates (≥11.5/HPF) before chemotherapy had significantly shorter overall survival than patients with low Treg infiltrates (<11.5/HPF). Cox multivariate regression analyses demonstrated that the density of Treg infiltration before chemotherapy was the strongest predictor for survival. This study established the predictive and prognostic effect of intratumoral FOXP3+ Tregs in LABC patients. To predict clinical outcome, evaluation of FOXP3+ Tregs in tumoral tissues before and after NAC should be considered for these high-risk patients.
authors.affiliation: Department of Medical Oncology, Ataturk Training and Research Hospital, Izmir Katip Celebi University, Basin Sitesi, Karabaglar, Izmir, Turkey, 35360, demir.lutfiye77@gmail.com.
authors.forename: Lutfiye
authors.initials: L
authors.lastname: Demir
authors.forename: Seyran
authors.initials: S
authors.lastname: Yigit
authors.forename: Hulya
authors.initials: H
authors.lastname: Ellidokuz
authors.forename: Cigdem
authors.initials: C
authors.lastname: Erten
authors.forename: Isil
authors.initials: I
authors.lastname: Somali
authors.forename: Yuksel
authors.initials: Y
authors.lastname: Kucukzeybek
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alacacioglu
authors.forename: Suna
authors.initials: S
authors.lastname: Cokmert
authors.forename: Alper
authors.initials: A
authors.lastname: Can
authors.forename: Murat
authors.initials: M
authors.lastname: Akyol
authors.forename: Ahmet
authors.initials: A
authors.lastname: Dirican
authors.forename: Vedat
authors.initials: V
authors.lastname: Bayoglu
authors.forename: Aysegul Akder
authors.initials: AA
authors.lastname: Sari
authors.forename: Mustafa Oktay
authors.initials: MO
authors.lastname: Tarhan
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000556:secondary; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000188:drug therapy / Q000276:immunology / Q000401:mortality* / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000556:secondary; D018275:Carcinoma, Lobular / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000556:secondary; D002291:Carcinoma, Papillary / Q000188:drug therapy / Q000276:immunology / Q000401:mortality / Q000556:secondary; D005260:Female; D005500:Follow-Up Studies; D051858:Forkhead Transcription Factors / Q000378:metabolism*; D006801:Humans; D007124:Immunoenzyme Techniques; D008207:Lymphatic Metastasis; D016246:Lymphocytes, Tumor-Infiltrating / Q000276:immunology / Q000473:pathology*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D012307:Risk Factors; D015996:Survival Rate; D050378:T-Lymphocytes, Regulatory / Q000276:immunology*
chemical_list: D051858:Forkhead Transcription Factors; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C418974:FOXP3 protein, human