Clinico-pathological relationship between androgen receptor and tumour infiltrating lymphocytes in triple negative breast cancer

Hagar Elghazawy; Joaira Bakkach; Thanaa Helal; Ahmed M Aref; Mohamed Kelany; Lamiaa E Abdallah; Fatma S Abdelbakey; Dalia Ali; Doaa Z Ali; Mai O Ahmed; Amer Ali Abd El-Hafeez; Pradipta Ghosh; Mohamed O Alorabi

doi:10.3332/ecancer.2021.1317

Clinico-pathological relationship between androgen receptor and tumour infiltrating lymphocytes in triple negative breast cancer

Ecancermedicalscience. 2021 Nov 11:15:1317. doi: 10.3332/ecancer.2021.1317. eCollection 2021.

Authors

Hagar Elghazawy^{1

2

3}, Joaira Bakkach^{4

2}, Thanaa Helal⁵, Ahmed M Aref⁶, Mohamed Kelany¹, Lamiaa E Abdallah¹, Fatma S Abdelbakey⁷, Dalia Ali¹, Doaa Z Ali⁶, Mai O Ahmed⁶, Amer Ali Abd El-Hafeez^{8

9}, Pradipta Ghosh^{9

10

11

12}, Mohamed O Alorabi¹

Affiliations

¹ Department of Clinical Oncology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt.
² Hagar Elghazawy and Joaira Bakkach had contributed equally to the work.
³ https://orcid.org/0000-0001-6839-4147.
⁴ Biomedical Genomics & Oncogenetics Research Laboratory, Faculty of Sciences and Techniques of Tangier, Abdelmalek Essaadi University, Tangier, 90 000, Morocco.
⁵ Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, 11591, Egypt.
⁶ Faculty of Biotechnology, October University for Modern Sciences and Arts (MSA), Giza, 12451, Egypt.
⁷ Department of Clinical Oncology, Electricity Hospital, Cairo, 11775, Egypt.
⁸ Pharmacology and Experimental Oncology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, 11796, Egypt.
⁹ Department of Cellular and Molecular Medicine, School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
¹⁰ Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
¹¹ Rebecca and John Moore Comprehensive Cancer Center, University of California, San Diego, La Jolla, CA 92037, USA.
¹² Veterans Affairs Medical Center, La Jolla, CA 92161, USA.

Abstract

Background: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with ill-defined therapeutic targets. Androgen receptor (AR) and tumour-infiltrating lymphocytes (TILs) had a prognostic and predictive value in TNBC. The relationship between AR, TILs and clinical behaviour is still not fully understood.

Methods: Thirty-six TNBC patients were evaluated for AR (positive if ≥1% expression), CD3, CD4, CD8 and CD20 by immunohistochemistry. Stromal TILs were quantified following TILs Working Group recommendations. Lymphocyte-predominant breast cancer (LPBC) was defined as stromal TILs ≥ 50%, whereas lymphocyte-deficient breast cancer (LDBC) was defined as <50%.

Results: The mean age was 52.5 years and 27.8% were ≥60 years. Seven patients (21.2%) were AR+. All AR+ cases were postmenopausal (≥50 years old). LPBC was 32.2% of the whole cohort. Median TILs were 37.5% and 10% (p = 0.1) and median CD20 was 20% and 7.5% (p = 0.008) in AR- and AR+, respectively. Mean CD3 was 80.7% and 93.3% (p = 0.007) and CD8 was 75% and 80.8% (p= 0.41) in AR- and AR+, respectively. All patients who were ≥60 years old expressed CD20. LDBC was found to be significantly higher in N+ versus N- patients (p = 0.03) with median TILs of 20% versus 50% in N+ versus N-, respectively (p = 0.03). LDBC was associated with higher risk of lymph node (LN) involvement (odds ratio = 6; 95% CI = 1.05-34.21; p = 0.04).

Conclusions: AR expression was evident in older age (≥50 years). Median CD20 was higher in AR- TNBC, while mean CD3 was higher in AR+ tumours. LDBC was associated with higher risk of LN involvement. Larger studies are needed to focus on the clinical impact of the relation between AR and TILs in TNBC.

Keywords: AR; TILs; TNBC; androgen receptor; triple negative breast cancer; tumour infiltrating lymphocytes.

Abstract

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