title: Intratumoral CD8⁺ cytotoxic lymphocyte is a favorable prognostic marker in node-negative breast cancer.
abstract: BACKGROUND
  The prognostic effect of tumor infiltrating CD8+ cytotoxic lymphocytes (CTLs) in breast cancer is controversial. We analyzed the association between CD8+ CTLs and survival of untreated node-negative breast cancer patients.
  
  
  METHODS
  CD8+ CTLs infiltrate was evaluated by immunostaining in a cohort of 332 node-negative breast cancer patients with a median follow-up of 152 months. The prognostic significance of CD8+ CTLs for disease-free survival (DFS) and breast cancer-specific overall survival (OS) was evaluated with Kaplan-Meier survival analysis as well as univariate analysis and multivariate Cox analysis adjusted for age at diagnosis, pT stage, histological grade, estrogen receptor (ER) status, progesterone receptor (PR) status, Ki-67 expression and human epidermal growth factor receptor 2 (HER-2) status.
  
  
  RESULTS
  285 (85.8%) patients showed strong CD8+ CTLs infiltrate positive status. Univariate analysis showed that CD8+ CTLs had statistically significant association with DFS (P = 0.004, hazard ratio [HR] = 0.454, 95% confidence interval [CI] = 0.265-0.777) and OS (P = 0.014, HR = 0.430, 95% CI = 0.220-0.840) in the entire cohort. The significance of CD8+ CTLs was especially strong in ER negative, HER-2 negative and ER, PR, HER-2 triple-negative breast cancers. In Kaplan-Meier analysis, CD8+ CTLs had significant effect on prognosis of patients (Log-rank test: P = 0.003 for DFS and P = 0.011 for OS), independent of established clinical factors for DFS (P = 0.002, HR = 0.418, 95% CI = 0.242-0.724) as well as for OS (P = 0.009, HR = 0.401, 95% CI = 0.202-0.797).
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Zonglin
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xianyu
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Enxiang
authors.initials: E
authors.lastname: Zhou
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Ganlong
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Qian
authors.affiliation: Department of Pathology, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xia
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xiongying
authors.initials: X
authors.lastname: Miao
authors.affiliation: Department of General Surgery, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Tang
mesh_terms: D001943:Breast Neoplasms / Q000378:metabolism* / Q000473:pathology*; D018414:CD8-Positive T-Lymphocytes / Q000378:metabolism*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D019394:Ki-67 Antigen / Q000378:metabolism; D008207:Lymphatic Metastasis / Q000276:immunology; D011379:Prognosis; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism
chemical_list: D019394:Ki-67 Antigen; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
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