Relationship between the ratio of mesenchymal cells or macrophages to cancer cells in lymphovascular invasion and clinicopathologic features and prognosis of pT1-4N1-3M0 breast cancer patients

doi:10.3877/cma.j.issn.1674-0807.2020.01.008

Abstract

Abstract:

Objective

To investigate the relationship between the ratio of mesenchymal cells to cancer cells or macrophages to cancer cells in lymphovascular invasion (LVI) and clinicopathologic features and prognosis of pT_1-4N_1-3M₀ breast cancer patients.

Methods

A total of 167 pT_1-4N_1-3M₀ breast cancer patients who received systemic treatment and had complete follow-up data in the First Affiliated Hospital of China Medical University, the First and Second Affiliated Hospitals of Dalian Medical University from January 2013 to December 2015 were enrolled in this retrospective study, with a median follow-up period of 55.2 months (16.8-69.6 months). Immunohistochemistry was used to identify the number of mesenchymal cells or macrophages in LVI. The ratio of mesenchymal cells to cancer cells and the ratio of macrophages to cancer cells in LVI were calculated. The Ward clustering method was used to divide the patients into two groups: high-ratio group and low-ratio group. Kruskal-Wallis H test and χ² test were used to analyze the relationship between the ratios and clinicopathologic features of breast cancer patients; the log-rank test was used to analyze the relationship between the ratios and the patient prognosis.

Results

The ratios [M(P₂₅-P₇₅)] of mesenchymal cells to cancer cells and macrophages to cancer cells in 167 patients were 0.025 (0.015-0.063) and 0.023 (0.015-0.036), respectively. The ratio of mesenchymal cells to cancer cells was correlated with histological grade, tumor size, lymph node metastasis, clinical stage and LVI (χ²=10.210, 6.210, 64.315, 56.901, 19.771; P=0.001, 0.045, and all P<0.001), but not correlated with ER, PR, HER-2, Ki67 expression and nerve invasion (χ²=3.148, 2.260, 3.187, 0.145, 1.384; P=0.076, 0.133, 0.074, 0.704, 0.240). The ratio of macrophages to cancer cells was correlated with tumor size, ER expression, nerve invasion, histological grade, lymph node metastasis, clinical stage, LVI and HER-2 expression(χ²=7.487, 6.680, 8.439, 13.002, 25.856, 31.394, 19.771, 27.921; P=0.024, 0.010, 0.004, all P<0.001), but not correlated with Ki67 and PR expression (χ²=3.616, 1.183; P=0.057, 0.277). After clustering, the ratio of mesenchymal cells to cancer cells was related to lymph node metastasis and clinical stage (χ²=47.3, P<0.001; χ²=14.260, P=0.001); the ratio of macrophages to cancer cells was related to ER expression (χ²=5.136, P=0.023). The patients with a higher ratio of mesenchymal cells or macrophages to cancer cells in LVI had a lower DFS (worse prognosis) (χ²=24.124, 18.746, both P<0.001).

Conclusion

High ratio of mesenchymal cells or macrophages to cancer cells in LVI suggests poor prognosis, so the ratio could serve as an indicator for recurrence risk of pT_1-4N_1-3M₀ breast cancer patients.

Key words: Mesenchymal cells, Macrophages, Breast neoplasms, Survival rate, Prognosis, Lymphovascular invasion, Tumor microenvironment

Lijuan Fan, Jia Wang, Xue Gao, Xiaoyun Mao, Xu Wang, Ang Zheng, Nan Ma, Feng Jin. Relationship between the ratio of mesenchymal cells or macrophages to cancer cells in lymphovascular invasion and clinicopathologic features and prognosis of pT_1-4N_1-3M₀ breast cancer patients[J]. Chinese Journal of Breast Disease(Electronic Edition), 2020, 14(01): 23-31.

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Figures/Tables 7

References 25

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临床病理特征		例数	间质细胞/癌细胞比值	χ²值^a	P值	巨噬细胞/癌细胞比值	χ²值^a	P值
组织学分级		?	?	?	?	?	?	?
?	2级	102	0.021(0.012～0.045)	10.210	0.001	0.020(0.013～0.031)	13.002	<0.001
?	3级	65	0.039(0.020～0.082)	10.210	0.001	0.030(0.019～0.042)	13.002	<0.001
肿瘤大小		?	?	?	?	?	?	?
?	1～10 mm	55	0.022(0.012～0.073)	6.210	0.045	0.019(0.012～0.035)	7.487	0.024
?	11～20 mm	95	0.021(0.015～0.058)			0.023(0.015～0.033)
?	>20 mm	17	0.045(0.026～0.078)			0.031(0.025～0.052)
腋窝淋巴结转移		?	?	?	?	?	?	?
?	1枚	46	0.015(0.012～0.025)	64.315	<0.001	0.015(0.010～0.023)	25.856	<0.001
?	2～3枚	57	0.018(0.013～0.025)			0.022(0.015～0.032)
?	4～5枚	35	0.044(0.023～0.058)			0.027(0.020～0.041)
?	>5枚	29	0.110(0.074～0.140)			0.034(0.025～0.049)
临床分期		?	?	?	?	?	?	?
?	Ⅰ期	16	0.012(0.010～0.014)	56.901	<0.001	0.011(0.008～0.015)	31.394	<0.001
?	Ⅱ期	86	0.018(0.013～0.028)			0.021(0.015～0.031)
?	Ⅲ期	65	0.057(0.036～0.113)			0.031(0.022～0.044)
脉管浸润		?	?	?	?	?	?	?
?	无	7	0(0)	19.771	<0.001	0(0)	19.771	<0.001
?	有	160	0.025(0.016～0.065)	19.771	<0.001	0.024(0.016～0.039)	19.771	<0.001
ER		?	?	?	?	?	?	?
?	阴性	48	0.037(0.018～0.080)	3.148	0.076	0.031(0.019～0.043)	6.68	0.010
?	阳性	119	0.021(0.014～0.057)	3.148	0.076	0.021(0.014～0.031)	6.68	0.010
PR		?	?	?	?	?	?	?
?	阴性	77	0.035(0.016～0.075)	2.260	0.133	0.024(0.017～0.042)	3.616	0.057
?	阳性	90	0.021(0.014～0.052)	2.260	0.133	0.021(0.014～0.031)	3.616	0.057
HER-2		?	?	?	?	?	?	?
?	阴性	130	0.021(0.014～0.061)	3.187	0.074	0.021(0.014～0.029)	27.921	<0.001
?	阳性	37	0.039(0.018～0.078)	3.187	0.074	0.042(0.031～0.050)	27.921	<0.001
Ki67		?	?	?	?	?	?	?
?	阴性	69	0.023(0.014～0.057)	0.145	0.704	0.022(0.015～0.031)	1.183	0.277
?	阳性	98	0.026(0.015～0.075)	0.145	0.704	0.024(0.015～0.041)	1.183	0.277
神经侵犯		?	?	?	?	?	?	?
?	无	137	0.026(0.015～0.069)	1.384	0.240	0.025(0.016～0.041)	8.439	0.004
?	有	30	0.020(0.015～0.047)	1.384	0.240	0.016(0.012～0.026)	8.439	0.004

临床病理特征		例数	间质细胞/癌细胞比值	χ²值^a	P值	巨噬细胞/癌细胞比值	χ²值^a	P值
组织学分级		?	?	?	?	?	?	?
?	2级	102	0.021(0.012～0.045)	10.210	0.001	0.020(0.013～0.031)	13.002	<0.001
?	3级	65	0.039(0.020～0.082)	10.210	0.001	0.030(0.019～0.042)	13.002	<0.001
肿瘤大小		?	?	?	?	?	?	?
?	1～10 mm	55	0.022(0.012～0.073)	6.210	0.045	0.019(0.012～0.035)	7.487	0.024
?	11～20 mm	95	0.021(0.015～0.058)			0.023(0.015～0.033)
?	>20 mm	17	0.045(0.026～0.078)			0.031(0.025～0.052)
腋窝淋巴结转移		?	?	?	?	?	?	?
?	1枚	46	0.015(0.012～0.025)	64.315	<0.001	0.015(0.010～0.023)	25.856	<0.001
?	2～3枚	57	0.018(0.013～0.025)			0.022(0.015～0.032)
?	4～5枚	35	0.044(0.023～0.058)			0.027(0.020～0.041)
?	>5枚	29	0.110(0.074～0.140)			0.034(0.025～0.049)
临床分期		?	?	?	?	?	?	?
?	Ⅰ期	16	0.012(0.010～0.014)	56.901	<0.001	0.011(0.008～0.015)	31.394	<0.001
?	Ⅱ期	86	0.018(0.013～0.028)			0.021(0.015～0.031)
?	Ⅲ期	65	0.057(0.036～0.113)			0.031(0.022～0.044)
脉管浸润		?	?	?	?	?	?	?
?	无	7	0(0)	19.771	<0.001	0(0)	19.771	<0.001
?	有	160	0.025(0.016～0.065)	19.771	<0.001	0.024(0.016～0.039)	19.771	<0.001
ER		?	?	?	?	?	?	?
?	阴性	48	0.037(0.018～0.080)	3.148	0.076	0.031(0.019～0.043)	6.68	0.010
?	阳性	119	0.021(0.014～0.057)	3.148	0.076	0.021(0.014～0.031)	6.68	0.010
PR		?	?	?	?	?	?	?
?	阴性	77	0.035(0.016～0.075)	2.260	0.133	0.024(0.017～0.042)	3.616	0.057
?	阳性	90	0.021(0.014～0.052)	2.260	0.133	0.021(0.014～0.031)	3.616	0.057
HER-2		?	?	?	?	?	?	?
?	阴性	130	0.021(0.014～0.061)	3.187	0.074	0.021(0.014～0.029)	27.921	<0.001
?	阳性	37	0.039(0.018～0.078)	3.187	0.074	0.042(0.031～0.050)	27.921	<0.001
Ki67		?	?	?	?	?	?	?
?	阴性	69	0.023(0.014～0.057)	0.145	0.704	0.022(0.015～0.031)	1.183	0.277
?	阳性	98	0.026(0.015～0.075)	0.145	0.704	0.024(0.015～0.041)	1.183	0.277
神经侵犯		?	?	?	?	?	?	?
?	无	137	0.026(0.015～0.069)	1.384	0.240	0.025(0.016～0.041)	8.439	0.004
?	有	30	0.020(0.015～0.047)	1.384	0.240	0.016(0.012～0.026)	8.439	0.004

聚类分析		例数	间质(巨噬)细胞/癌细胞比值[M(P₂₅～P₇₅)]	χ²值^a	P值
间质细胞聚类		?	?	?	?
?	低比值组	140	0.021(0.013～0.041)	67.571	<0.001
?	高比值组	27	0.142(0.116～0.172)	67.571	<0.001
巨噬细胞聚类		?	?	?	?
?	低比值组	151	0.021(0.014～0.031)	43.186	<0.001
?	高比值组	16	0.088(0.072～0.113)	43.186	<0.001

聚类分析		例数	间质(巨噬)细胞/癌细胞比值[M(P₂₅～P₇₅)]	χ²值^a	P值
间质细胞聚类		?	?	?	?
?	低比值组	140	0.021(0.013～0.041)	67.571	<0.001
?	高比值组	27	0.142(0.116～0.172)	67.571	<0.001
巨噬细胞聚类		?	?	?	?
?	低比值组	151	0.021(0.014～0.031)	43.186	<0.001
?	高比值组	16	0.088(0.072～0.113)	43.186	<0.001

临床病理特征		例数	间质细胞/癌细胞		χ²值	P值	巨噬细胞/癌细胞		χ²值	P值
临床病理特征		例数	低比值	高比值	χ²值	P值	低比值	高比值	χ²值	P值
组织学分级		?	?	?	?	?	?	?	?	?
?	2级	102	90(88.2)	12(11.8)	3.748	0.053	93(91.2)	9(8.8)	0.173	0.677
?	3级	65	50(76.9)	15(23.1)	3.748	0.053	58(89.2)	7(10.8)	0.173	0.677
肿瘤大小		?	?	?	?	?	?	?	?	?
?	1～10 mm	55	47(85.5)	8(14.5)	0.797	0.671	51(92.7)	4(7.3)	4.304	0.116
?	11～20 mm	95	80(84.2)	15(15.8)			87(91.6)	8(8.4)
?	>20 mm	17	13(13/17^a)	4(4/17^a)			13(13/17^a)	4(4/17^a)
腋窝淋巴结转移		?	?	?	?	?	?	?	?	?
?	1枚	46	43(93.5)	3(6.5)	47.300	<0.001	43(93.5)	3(6.5)	5.993	0.112
?	2～3枚	57	54(94.7)	3(5.3)			54(94.7)	3(5.3)
?	4～5枚	35	31(88.6)	4(11.4)			31(88.6)	4(11.4)
?	>5枚	29	12(41.4)	17(58.6)			23(79.3)	6(20.7)
临床分期		?	?	?	?	?	?	?	?	?
?	Ⅰ期	16	16(16/16^a)	0(0)	14.260	0.001	16(16/16^a)	0(0)	3.267	0.195
?	Ⅱ期	86	78(90.7)	8(9.3)			79(91.9)	7(8.1)
?	Ⅲ期	65	46(70.8)	19(29.2)			56(86.2)	9(13.8)
脉管浸润		?	?	?	?	?	?	?	?	?
?	无	7	7(7/7^a)	0(0)	0.439	0.508	7(7/7^a)	0(0)	?	1.000^b
?	有	160	133(83.1)	27(16.9)	0.439	0.508	144(90.0)	16(10.0)	?	1.000^b
ER		?	?	?	?	?	?	?	?	?
?	阴性	48	40(83.3)	8(16.7)	0.012	0.991	39(81.2)	9(18.8)	5.136	0.023
?	阳性	119	100(84.0)	19(16.0)	0.012	0.991	112(94.1)	7(5.9)	5.136	0.023
PR		?	?	?	?	?	?	?	?	?
?	阴性	77	64(83.1)	13(16.9)	0.054	0.816	67(87.0)	10(13.0)	1.914	0.167
?	阳性	90	76(84.4)	14(15.6)	0.054	0.816	84(93.3)	6(6.7)	1.914	0.167
HER-2		?	?	?	?	?	?	?	?	?
?	阴性	130	109(83.8)	21(16.2)	<0.001	0.993	120(92.3)	10(7.7)	1.532	0.216
?	阳性	37	31(83.8)	6(16.2)	<0.001	0.993	31(83.8)	6(16.2)	1.532	0.216
Ki67		?	?	?	?	?	?	?	?	?
?	阴性	69	59(85.5)	10(14.5)	0.243	0.622	64(92.8)	5(7.2)	0.740	0.390
?	阳性	98	81(82.7)	17(17.3)	0.243	0.622	87(88.8)	11(11.2)	0.740	0.390
神经侵犯		?	?	?	?	?	?	?	?	?
?	无	137	113(82.5)	24(17.5)	0.547	0.460	121(88.3)	16(11.7)	2.644	0.104
?	有	30	27(90.0)	3(10.0)	0.547	0.460	30(100)	0(0)	2.644	0.104

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Relationship between the ratio of mesenchymal cells or macrophages to cancer cells in lymphovascular invasion and clinicopathologic features and prognosis of pT_1-4N_1-3M₀ breast cancer patients

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