Document Type : Original Article
Authors
1
Student Research Committee, Faculty of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2
Department of pathology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
3
Poursina Hakim Digestive Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4
Department of Radiotherapy and Oncology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
10.22034/jcrph.2026.568721.1019
Abstract
Background: Triple-negative breast cancer (TNBC) is biologically heterogeneous, and selecting among chemotherapy protocols remains challenging. Stromal tumor-infiltrating lymphocytes (sTILs) capture baseline antitumor immunity and may improve prognostic stratification and interpretation of regimen-associated outcomes.
Methods: We retrospectively analyzed women with TNBC treated with neoadjuvant or adjuvant chemotherapy between March 2016 and March 2019. sTILs were scored on pretreatment hematoxylin-and-eosin biopsy sections by two pathologists using International TILs Working Group recommendations. Lymphocyte-predominant breast cancer (LPBC) was defined as sTILs ≥50%. Overall survival (OS) was measured from pathologic diagnosis to death from any cause or last follow-up and compared using Kaplan-Meier curves and log-rank tests.
Results: Ninety-six patients with non-metastatic TNBC were included (median follow-up, 36 months). sTILs ranged from 1% to 90% (median, 10%); 13 patients (13.5%) had LPBC. Median OS was not reached; 5-year OS was 65%. Five-year OS was higher in LPBC than in low sTIL tumors (83% vs 63%; P=0.046). In the low sTIL stratum, OS did not differ significantly among AC→T, EC→T, and TC. Carboplatin-containing regimens (n=4) showed poorer OS, but this estimate is imprecise and hypothesis-generating.
Conclusions: sTILs provided prognostic stratification in non-metastatic TNBC. In immune-low tumors, AC→T, EC→T, and TC showed comparable OS. The poorer OS with carboplatin-containing regimens was based on only 4 patients and is hypothesis-generating, requiring confirmation in larger, risk-adjusted studies that distinguish platinum addition from substitution.
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