Higher Absolute Lymphocyte Counts Predict Lower Mortality from Early-Stage Triple-Negative Breast Cancer

• Published in: Clinical cancer research 2018-06, Vol.24 (12), p.2851-2858
• Main Authors: Afghahi, Anosheh, Purington, Natasha, Han, Summer S, Desai, Manisha, Pierson, Emma, Mathur, Maya B, Seto, Tina, Thompson, Caroline A, Rigdon, Joseph, Telli, Melinda L, Badve, Sunil S, Curtis, Christina N, West, Robert B, Horst, Kathleen, Gomez, Scarlett L, Ford, James M, Sledge, George W, Kurian, Allison W
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers; Biomarkers, Tumor; BRCA1 protein; Breast cancer; California - epidemiology; Cancer; Cancer therapies; Cell number; Chemotherapy; Confidence intervals; Demographics; Diagnostic systems; Electronic health records; Electronic medical records; Experimental design; Health care; Humans; Immune response; Lymphocyte Count; Lymphocytes; Lymphocytes, Tumor-Infiltrating - immunology; Lymphocytes, Tumor-Infiltrating - pathology; Lymphopenia; Middle Aged; Minority & ethnic groups; Mortality; Mutation; Neoplasm Staging; Patients; Prognosis; Proportional Hazards Models; Radiation therapy; Registries; Regression analysis; Regression models; SEER Program; Socioeconomics; Statistical analysis; Subgroups; Triple Negative Breast Neoplasms - blood; Triple Negative Breast Neoplasms - diagnosis; Triple Negative Breast Neoplasms - mortality; Triple Negative Breast Neoplasms - therapy; Tumor-infiltrating lymphocytes
• ISSN: 1078-0432; 1557-3265; 1557-3265
• DOI: 10.1158/1078-0432.ccr-17-1323

Tumor-infiltrating lymphocytes (TIL) in pretreatment biopsies are associated with improved survival in triple-negative breast cancer (TNBC). We investigated whether higher peripheral lymphocyte counts are associated with lower breast cancer-specific mortality (BCM) and overall mortality (OM) in TNBC. Data on treatments and diagnostic tests from electronic medical records of two health care systems were linked with demographic, clinical, pathologic, and mortality data from the California Cancer Registry. Multivariable regression models adjusted for age, race/ethnicity, socioeconomic status, cancer stage, grade, neoadjuvant/adjuvant chemotherapy use, radiotherapy use, and germline mutations were used to evaluate associations between absolute lymphocyte count (ALC), BCM, and OM. For a subgroup with TIL data available, we explored the relationship between TILs and peripheral lymphocyte counts. A total of 1,463 stage I-III TNBC patients were diagnosed from 2000 to 2014; 1,113 (76%) received neoadjuvant/adjuvant chemotherapy within 1 year of diagnosis. Of 759 patients with available ALC data, 481 (63.4%) were ever lymphopenic (minimum ALC