Cytotoxic T Lymphocyte Count and Survival Time in Women with Metastatic Breast Cancer

Abstract

While prognostic factors in early stage breast cancer are well documented, few studies have examined predictors of the rate of metastatic progression. The purpose of this study was to examine cytotoxic T-cell lymphocyte (CTL) count as a marker of disease status in women with metastatic breast cancer. This study examined CTL subset counts as predictors of subsequent survival in 113 women with metastatic or recurrent breast cancer. Samples were measured by flow cytometry using monoclonal antibodies for cell surface antigens for percentages and absolute numbers of CTLs (CD3/CD8), total lymphocytes, T cells (CD3), helper T cells (CD3/CD4), and total white blood cell (TWC) count. Higher CTL counts emerged as a significant predictor of longer survival up to 7 years later (Wald = 7.40, p = 0.007; Cox regression model). The relationship of higher CTL count with enhanced survival was independent of the effects of medical treatment. CTLs were significantly associated with TWC count (r = 0.42, p < 0.001). However, TWC count was not associated with subsequent survival time. Higher CTL count was associated with Karnofsky performance status (r = 0.27, p = 0.004). However, after adjustment for the Karnofsky score, the CTL count/survival relationship remained significant (Wald = 4.33, p = 0.038). In conclusion, there is a robust relationship between CTL count and survival that is independent of the effects of medical treatments, TWC count, and Karnofsky performance status. Moreover, a reduced CTL count may be a mediator or marker of more rapid disease progression in metastatic breast cancer.

Prognostic Significance of Peripheral Blood Flow Cytometry Parameters in Patients with Non-Metastatic Breast Cancer

“…In patients with advanced stage cancer, decreased numbers of CTLs do not inhibit the spread of tumor cells (Liang et al, 1993). This is consistent with the lower percentages of CTLs in metastatic cancer patients compared to non metastatic cancer patients (Blake-Mortimer et al, 2004).…”

“…Also, a significant reduction in the percentages of peripheral CTLs has been found in breast cancer patients with metastases compared to those without metastases (Liang et al, 1993;Alkhateeb et al, 2013). Consistent with these findings, a progressive decrease in both CD4 and CD8 cells has been associated with the spread of disease in patients with breast, malignant melanoma, lung, and colorectal cancers (Blake-Mortimer et al, 2004). Melichar et al found that CD8+CD28+ T cell counts were significantly lower in breast cancer patients then controls but CD8+CD28+ T cell levels increased following doxorubucin-paclitaxel chemotherapy.…”

“…We couldn't find a significant relation between OS and CD8+CD28-in breast cancer but found a significant relation between OS and CD8+CD28+ T cells. Mortimer et al revealed that there is a robust relationship between CTL count and survival independent of the effects of medical treatment in patients with metastatic breast cancer (Blake-Mortimer et al, 2004). Also, a significant reduction in the percentages of peripheral CTLs has been found in breast cancer patients with metastases compared to those without metastases (Liang et al, 1993;Alkhateeb et al, 2013).…”

Prognostic value of neutrophil/lymphocyte ratio in patients with pulmonary embolism

“…Recent data demonstrate that a low number of lymphocytes in a colorectal tumor is associated with poor prognosis. The prognostic value of NLR was investigated in patients diagnosed with colorectal, ovary, and lung cancer and those who underwent liver transplantation, and a strong correlation was found with overall survival (14)(15)(16)(17)(18)(19).…”

Evaluation of immune status in patients with breast cancer in Sokoto, Northwestern, Nigeria

“…It is estimated that worldwide over 50, 8000 women died in 2011 due to breast cancer. 3 Breast cancer is the leading cause of cancer death among females accounting for 23% (1.38 million) of the total cancer cases and 14% (458,400) of the cancer deaths in women. 4,5 Breast cancer is a major public health problem especially in Sub-Saharan Africa, Nigeria inclusive.…”