Tumor infiltrating lymphocytes and change in tumor load on MRI to assess response and prognosis after neoadjuvant chemotherapy in breast cancer

Janssen, LM; Penning de Vries, BBL; Janse, MHA; van der Wall, E; Elias, SG; Salgado, R; van Diest, PJ; Gilhuijs, KGA

Author(s): Janssen, LM; Penning de Vries, BBL; Janse, MHA; van der Wall, E; Elias, SG; Salgado, R; van Diest, PJ; Gilhuijs, KGA;
Details: Publication Year 2025-01,Volume 209,Issue #1,Page 167-175
Journal Title: Breast Cancer Research and Treatment
Publication Type: Research article
Abstract: PURPOSE: In this study, we aimed to explore if the combination of tumor infiltrating lymphocytes (TILs) and change in tumor load on dynamic contrast-enhanced magnetic resonance imaging leads to better assessment of response to neoadjuvant chemotherapy (NAC) in patients with breast cancer, compared to either alone. METHODS: In 190 NAC treated patients, MRI scans were performed before and at the end of treatment. The percentage of stromal TILs (%TILs) was assessed in pre-NAC biopsies according to established criteria. Prediction models were developed with linear regression by least absolute shrinkage and selection operator and cross validation (CV), with residual cancer burden as the dependent variable. Discrimination for pathological complete response (pCR) was evaluated using area under the receiver operating characteristic curves (AUC). We used Cox regression analysis for exploring the association between %TILs and recurrence-free survival (RFS). RESULTS: Fifty-one patients reached pCR. In all patients, the %TILs model and change in MRI tumor load model had an estimated CV AUC of 0.69 (95% confidence interval (CI) 0.53-0.78) and 0.69 (95% CI 0.61-0.79), respectively, whereas a model combining the variables resulted in an estimated CV AUC of 0.75 (95% CI 0.66-0.83). In the group with tumors that were ER positive and HER2 negative (ER+/HER2-) and in the group with tumors that were either triple negative or HER2 positive (TN&HER2+) separately, the combined model reached an estimated CV AUC of 0.72 (95% CI 0.60-0.88) and 0.70(95% CI 0.59-0.82), respectively. A significant association was observed between pre-treatment %TILS and RFS (hazard ratio (HR) 0.72 (95% CI 0.53-0.98), for every standard deviation increase in %TILS, p = 0.038). CONCLUSION: The combination of TILs and MRI is informative of response to NAC in patients with both ER+/HER2- and TN&HER2+ tumors.
Publisher: Springer Nature
Keywords: Humans; Female; *Lymphocytes, Tumor-Infiltrating/immunology/pathology; Neoadjuvant Therapy; *Magnetic Resonance Imaging/methods; Middle Aged; *Breast Neoplasms/drug therapy/pathology/diagnostic imaging/mortality/immunology; Prognosis; Adult; Aged; Tumor Burden; Treatment Outcome; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Chemotherapy, Adjuvant; ROC Curve; Breast cancer; Magnetic resonance imaging; Neoadjuvant chemotherapy; Pathological complete response; Tumor infiltrating tumor cells
Department(s): Laboratory Research
Publisher's Version: https://doi.org/10.1007/s10549-024-07484-7
Open Access at Publisher's Site: https://doi.org/10.1007/s10549-024-07484-7
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2026-01-13 04:29:44

Last Modified: 2026-01-13 04:29:53