Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer

Anosheh Afghahi, Natasha Purington, Summer S. Han, Manisha Desai, Emma Pierson, Maya B. Mathur, Tina Seto, Caroline A. Thompson, Joseph Rigdon, Melinda L. Telli, Sunil Badve, Christina N. Curtis, Robert B. West, Kathleen Horst, Scarlett L. Gomez, James M. Ford, George W. Sledge, Allison W. Kurian

Research output: Contribution to journalArticle

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Abstract

Purpose: 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. Experimental Design: 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 BRCA1/2 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. Results: 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<1.0 K/μL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR = 0.23; 95% confidence interval (CI), 0.16–0.35] and BCM (HR = 0.19; CI, 0.11–0.34). Five-year probability of BCM was 15% for patients who were ever lymphopenic versus 4% for those who were not. An exploratory analysis (n = 70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy. Conclusions: Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment.

Original languageEnglish (US)
Pages (from-to)2851-2858
Number of pages8
JournalClinical Cancer Research
Volume24
Issue number12
DOIs
StatePublished - Jun 15 2018

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Triple Negative Breast Neoplasms
Lymphocyte Count
Mortality
Breast
Tumor-Infiltrating Lymphocytes
Adjuvant Chemotherapy
Confidence Intervals
Electronic Health Records
Routine Diagnostic Tests
Social Class
Registries
Neoplasms
Neutrophils
Research Design
Radiotherapy
Demography
Delivery of Health Care
Biopsy
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Afghahi, A., Purington, N., Han, S. S., Desai, M., Pierson, E., Mathur, M. B., ... Kurian, A. W. (2018). Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer. Clinical Cancer Research, 24(12), 2851-2858. https://doi.org/10.1158/1078-0432.CCR-17-1323

Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer. / 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; Curtis, Christina N.; West, Robert B.; Horst, Kathleen; Gomez, Scarlett L.; Ford, James M.; Sledge, George W.; Kurian, Allison W.

In: Clinical Cancer Research, Vol. 24, No. 12, 15.06.2018, p. 2851-2858.

Research output: Contribution to journalArticle

Afghahi, A, Purington, N, Han, SS, Desai, M, Pierson, E, Mathur, MB, Seto, T, Thompson, CA, Rigdon, J, Telli, ML, Badve, S, Curtis, CN, West, RB, Horst, K, Gomez, SL, Ford, JM, Sledge, GW & Kurian, AW 2018, 'Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer', Clinical Cancer Research, vol. 24, no. 12, pp. 2851-2858. https://doi.org/10.1158/1078-0432.CCR-17-1323
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 ; Curtis, Christina N. ; West, Robert B. ; Horst, Kathleen ; Gomez, Scarlett L. ; Ford, James M. ; Sledge, George W. ; Kurian, Allison W. / Higher absolute lymphocyte counts predict lower mortality from early-stage triple-negative breast cancer. In: Clinical Cancer Research. 2018 ; Vol. 24, No. 12. pp. 2851-2858.
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abstract = "Purpose: 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. Experimental Design: 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 BRCA1/2 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. Results: 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<1.0 K/μL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR = 0.23; 95{\%} confidence interval (CI), 0.16–0.35] and BCM (HR = 0.19; CI, 0.11–0.34). Five-year probability of BCM was 15{\%} for patients who were ever lymphopenic versus 4{\%} for those who were not. An exploratory analysis (n = 70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy. Conclusions: Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment.",
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AU - Afghahi, Anosheh

AU - Purington, Natasha

AU - Han, Summer S.

AU - Desai, Manisha

AU - Pierson, Emma

AU - Mathur, Maya B.

AU - Seto, Tina

AU - Thompson, Caroline A.

AU - Rigdon, Joseph

AU - Telli, Melinda L.

AU - Badve, Sunil

AU - Curtis, Christina N.

AU - West, Robert B.

AU - Horst, Kathleen

AU - Gomez, Scarlett L.

AU - Ford, James M.

AU - Sledge, George W.

AU - Kurian, Allison W.

PY - 2018/6/15

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N2 - Purpose: 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. Experimental Design: 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 BRCA1/2 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. Results: 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<1.0 K/μL). On multivariable analysis, higher minimum ALC, but not absolute neutrophil count, predicted lower OM [HR = 0.23; 95% confidence interval (CI), 0.16–0.35] and BCM (HR = 0.19; CI, 0.11–0.34). Five-year probability of BCM was 15% for patients who were ever lymphopenic versus 4% for those who were not. An exploratory analysis (n = 70) showed a significant association between TILs and higher peripheral lymphocyte counts during neoadjuvant chemotherapy. Conclusions: Higher peripheral lymphocyte counts predicted lower mortality from early-stage, potentially curable TNBC, suggesting that immune function may enhance the effectiveness of early TNBC treatment.

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