Sentinel lymph node B cells can predict disease-free survival in breast cancer patients

• Published in: NPJ breast cancer 2018-08, Vol.4 (1), p.28-7, Article 28
• Main Authors: Blenman, Kim R. M., He, Ting-Fang, Frankel, Paul H., Ruel, Nora H., Schwartz, Erich J., Krag, David N., Tan, Lee K., Yim, John H., Mortimer, Joanne E., Yuan, Yuan, Lee, Peter P.
• Format: Article
• Language: English
• Subjects: 631/67/580/1884; 692/53/2422; Biomedical and Life Sciences; Biomedicine; Breast cancer; Cancer Research; Cell Biology; Human Genetics; Lymphatic system; Medical prognosis; Multivariate analysis; Oncology
• ISSN: 2374-4677; 2374-4677
• DOI: 10.1038/s41523-018-0081-7

Tumor invasion into draining lymph nodes, especially sentinel lymph nodes (SLNs), is a key determinant of prognosis and treatment in breast cancer as part of the TNM staging system. Using multicolor histology and quantitative image analysis, we quantified immune cells within SLNs from a discovery cohort of 76 breast cancer patients. We found statistically more in situ CD3 + T cells in tumor negative vs. tumor positive nodes (mean of 8878 vs. 6704, respectively, p  = 0.006), but no statistical difference in CD20 + B cells or CD1a + dendritic cells. In univariate analysis, a reduced hazard was seen with a unit increase in log CD3 with HR 0.49 (95% CI 0.30–0.80) and log CD20 with HR 0.37 (95% CI 0.22–0.62). In multivariate analysis, log CD20 remained significant with HR 0.42 (95% CI 0.25–0.69). When restricted to SLN tumor negative patients, increased log CD20 was still associated with improved DFS (HR = 0.26, 95% CI 0.08–0.90). The CD20 results were validated in a separate cohort of 21 patients ( n  = 11 good outcome, n  = 10 poor outcome) with SLN negative triple-negative breast cancer (TNBC) (“good” mean of 7011 vs. “poor” mean of 4656, p  = 0.002). Our study demonstrates that analysis of immune cells within SLNs, regardless of tumor invasion status, may provide additional prognostic information, and highlights B cells within SLNs as important in preventing future recurrence. Immunology: Lymph nodes full of B cells linked to better outcomes B cells within the tumor-draining lymph nodes may have an important biological role in preventing relapse of breast cancer. A team led by Peter Lee from City of Hope in Duarte, California, USA, quantified the levels of three populations of immune cells—T cells, B cells and dendritic cells—within sentinel lymph nodes biopsied from a cohort of 76 patients. They found that larger numbers of T cells and B cells were both linked to longer progression-free survival in the women. However, after statistically accounting for correlations between the two immune cell types, the researchers concluded that B cells had the dominant beneficial effect on survival times. They validated the finding that high B-cell counts are a prognostic indicator of better outcomes in a separate cohort of 21 women with triple-negative breast cancer.