THE PROGNOSTIC SIGNIFICANCE OF TUMOR-INFILTRATING LYMPHOCYTES IN RESECTABLE TRIPLE-NEGATIVE BREAST CANCER—INSIGHTS FROM SEVEN YEARS OF REAL-WORLD DATA
DOI:
https://doi.org/10.55374/jseamed.v10.255Keywords:
triple-negative breast cancer, tumor-infiltrating lymphocytes (TILs), prognosis, relapse-free survival, breast cancer-specific survival, Southeast Asia, ThailandAbstract
Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited treatment options and a high risk of recurrence. Tumor-infiltrating lymphocytes (TILs) are potential prognostic markers of TNBC. While studies in Western populations suggest favorable outcomes with higher TIL levels, evidence from Southeast Asian populations remains limited. Objectives: This study aimed to evaluate the prognostic impact of TIL levels on survival outcomes in patients with resectable TNBC.
Methods: We retrospectively reviewed patients with resectable TNBC who underwent upfront surgery at the Ramathibodi Comprehensive Cancer Center in Thailand between 2015 and 2019. All patients were staged according to the AJCC 8th edition. TILs were assessed using the International TILs Working Group 2014 guidelines. The patients were categorized by TIL levels. The primary endpoint was relapse-free survival (RFS), and patients with TILs ≥30% were compared with those with TILs <30%. Secondary endpoints included RFS with TILs cutoffs (≥ 10% and ≥20%), breast cancer-specific survival (BCSS), and overall survival (OS).
Results: The study included 128 patients with a median follow-up of 83 months. Adjuvant chemotherapy was administered in 84.4% of cases, whereas omission was mainly in older or comorbid patients. Patients with TILs ≥30% showed a favorable but non-significant trend toward improved RFS (HR 0.54; 95% CI, 0.20–1.49; p = 0.238), BCSS (HR 0.43; 95% CI, 0.09–1.97), and OS (HR 0.67; 95% CI, 0.22–2.06). Lower TIL thresholds (≥10%, ≥20%) were not associated with improved outcomes. A multivariate analysis showed no independent prognostic effect of TILs.
Conclusion: Although statistical significance was not reached, TIL levels ≥30% were associated with a favorable survival trend. To our knowledge, this is the largest Southeast Asian cohort with long-term follow-up, providing region-specific real-world evidence. These findings illustrate that TIL assessment on routine H&E slides is feasible and practical, especially in resource-constrained settings, and highlight the need for larger prospective studies to clarify the prognostic and predictive role of TILs in the immunotherapy era.
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