Be sTIL my heart.

Top Line: We’re all familiar with the notorious new prognostic staging of breast cancer, but it’s really only the ER(+) variety that seems to enjoy down-staging as a result.
The Study: Much like Oncotype DX, assessing the percentage of tumor stroma infiltrated by lymphocytes is a reproducible way to identify triple-negative breast cancers (TNBC) with superior prognosis. Much unlike Oncotype Dx, stromal tumor-infiltrating lymphocytes (sTILs) can be simply and cheaply assessed on standard H&E slides already prepared. This meta-analysis aimed to “conclusively” establish the prognostic value of sTILs in TNBC. It included over 2000 patients with early-stage TNBC receiving adjuvant anthracycline-based chemo across 8 prospective trials and 1 large retrospective cohort. The kicker was that all studies had to use the same H&E method to quantify sTILs. Overall, three-quarters of samples had at least 1% sTILs. A stronger presence was found among tumors that were higher grade, were smaller, involved less nodes and were from younger patients. Most importantly, each 10% increase in sTILs carried a hazard ratio of 0.83-0.87 for survival free of invasive and distant disease as well as overall survival.
Bottom Line: TBNC deserves its own additional layers of prognostications in the next iteration of staging, and thank goodness these authors include a web-based calculator to incorporate the prognostic power of sTILs. | Loi, J Clin Oncol 2019


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