目的 探讨 FOXP3 +肿瘤浸润性淋巴细胞(TILs)与乳腺癌临床病理特征之间的相关性及其预后的意义。 方法 选取 2009 年 1 月至 2013 年 5 月期间首都医科大学附属北京世纪坛医院治疗的 156 例浸润性乳腺癌患者,采用免疫组化方法检测 FOXP3 +和 CD4 +的蛋白表达,记录患者的年龄、肿瘤大小、肿瘤分期、淋巴结转移情况、组织学分级、雌激素受体(ER)、孕激素 受体(PR)、人表皮生长因子受体-2(HER-2)、Ki-67 指数、无病生存(DFS)率和总生存(OS)率,探讨 FOXP3 + TILs 与临床病 理特征之间的相关性,使用 Kaplan-Meier 曲线和 Cox 比例风险模型进行生存分析。 结果 156 例浸润性乳腺癌患者的中位年 龄为 51 岁(32~ 70 岁),乳腺癌组织中,FOXP3 + 高表达的患者 51 例( 32. 7%),FOXP3 + 的表达在肿瘤的组织学分级( P = 0. 021)、PR(P= 0. 016)、HER-2(P= 0. 018)、Ki-67 指数(P = 0. 042)、腋窝淋巴结转移(P = 0. 001)方面的差异均有统计学意 义。 CD4 + TILs 的表达与所有患者的临床病理特征均无明显相关性。 生存分析显示,FOXP3 +高表达患者的 OS 率低于 FOXP3 + 低表达患者的 OS 率(64. 7% 比 87. 6%,χ 2 = 15. 3,P < 0. 001)。 FOXP3 + 高表达患者的 DFS 率也低于低表达患者的 DFS 率 (56. 9% 比 80. 0%,χ 2 = 13. 1,P <0. 001),差异有统计学意义。 在 74 例腋窝淋巴结转移阳性的患者中,FOXP3 +高表达患者的 DFS 率低于 FOXP3 +低表达患者的 DFS 率,差异有统计学意义(χ 2 = 5. 730,P < 0. 001)。 在多因素 Cox 生存分析显示,FOXP3 + TILs 是乳腺癌患者 OS[HR = 2. 732( 95% CI = 1. 174 ~ 6. 207),P = 0. 023] 和 DFS[HR = 2. 092( 95% CI = 1. 068 ~ 4. 088),P = 0. 032]预后不良的独立影响因素。 结论 FOXP3 +高表达患者的 OS 率和 DFS 率均低于 FOXP3 +低表达患者,FOXP3 + TILs 可作 为乳腺癌患者的独立不良预后因素。

Objective To detect the expression of FOXP3 + TILs in primary invasive breast cancer analyze the correlation between the expression level of FOXP3 + TILs and the clinicopathological characteristics of breast cancer and explore the relationship between FOXP3 + TILs and the prognosis of breast cancer. Method Surgically resected samples from 156 patients with invasive breast cancer BC were assessed for the expression of FOXP3 + TILs and CD4 + TILs by immunohistochemistry. The correlation between FOXP3 + TILs and the patients ' clinicopathological characteristics was explored. Kaplan - Meier survival analysis and Cox proportional hazards regression model were used to assess the correlation between FOXP3 + TILs and breast cancer-specific survival and to stratify the evaluation of breast cancer subtypes. Result Elevated FOXP3 + TILs infiltration were significantly correlated with high histological grade P= 0. 021 positive human epidermal growth factor receptor-2 HER-2 P=0. 018 Progesterone receptor expression PR P=0. 016 high Ki-67 index P = 0. 042 and axillary lymph node metastases P = 0. 001 . There was no significant correlation between CD4 + TILs expression and the clinicopathological features of all patients. Tumors with concomitant high expressions of FOXP3 + TILs had worse overall survival OS and disease-free survival DFS 64. 7% vs 87. 6% χ 2 = 15. 3 P<0. 001 56. 9% vs 80. 0% χ 2 = 13. 1 P<0. 001 . The patients with axillary lymph node metastases with the high expressions of FOXP3 + TILs infiltration had worse DFS P<0. 001 . Multivariate analysis showed that FOXP3 + TILs was independent predictors of OS HR=2. 732 95%CI=1. 174~6. 207 P=0. 023 and DFS HR=2. 092 95%CI= 1. 068~4. 088 P = 0. 032 . Conclusion The high expression of FOXP3 + TILs in breast cancer is associated with tumor progression higher expression of FOXP3 + TILs indicates wores OS and DFS FOXP3 + TILs maybe a prognostic marker for breast cancer.