Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Jul 24, 2024; 15(7): 920-935
Published online Jul 24, 2024. doi: 10.5306/wjco.v15.i7.920
Predictive value of tumor-infiltrating lymphocytes for neoadjuvant therapy response in triple-negative breast cancer: A systematic review and meta-analysis
Hai-Kuan Sun, Wen-Long Jiang, Shi-Lei Zhang, Peng-Cheng Xu, Li-Min Wei, Jiang-Bo Liu
Hai-Kuan Sun, Wen-Long Jiang, Shi-Lei Zhang, Peng-Cheng Xu, Li-Min Wei, Jiang-Bo Liu, Department of Thyroid and Breast Surgery, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang 471000, Henan Province, China
Co-first authors: Hai-Kuan Sun and Wen-Long Jiang.
Author contributions: Sun HK and Jiang WL acquisition of data, analysis, and interpretation of data, drafting the article, final approval; Zhang SL, Xu PC, and Wei LM interpretation of data, revising the article, final approval; Liu JB conception and design of the study, critical revision, final approval. Sun HK and Jiang WL contributed equally to this work as co-first authors. The reasons for designating Sun HK and Jiang WL as co-first authors are as follows: First, Sun HK and Jiang WL spent equal time and effort on acquisition of data, analysis, and interpretation of data during the literature eligibility and data analytical process. Second, during the preparation of our manuscript, Sun HK and Jiang WL achieve equal contribution in drafting and final approval of article. Finally, co-first authorship of Sun HK and Jiang WL indicate that the two co-first authors have equal responsibilities and burdens associated with the quality and reliability of the article. In summary, we believe that designating Sun HK and Jiang WL as co-first authors for our manuscript is appropriate as it accurately reflects our team's collaborative spirit and equal contributions.
Supported by Henan Province Medical Science and Technology Tackling Plan Joint Construction Project, No. LHGJ20220684.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jiang-Bo Liu, Doctor, PhD, Associate Professor, Department of Thyroid and Breast Surgery, The First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, No. 24 Jinghua Road, Luoyang 471000, Henan Province, China. jiangboliuxing@163.com
Received: March 9, 2024
Revised: May 21, 2024
Accepted: June 6, 2024
Published online: July 24, 2024
Processing time: 128 Days and 15 Hours
Abstract
BACKGROUND

The association between tumor-infiltrating lymphocyte (TIL) levels and the response to neoadjuvant therapy (NAT) in patients with triple-negative breast cancer (TNBC) remains unclear.

AIM

To investigate the predictive potential of TIL levels for the response to NAT in TNBC patients.

METHODS

A systematic search of the National Center for Biotechnology Information PubMed database was performed to collect relevant published literature prior to August 31, 2023. The correlation between TIL levels and the NAT pathologic complete response (pCR) in TNBC patients was assessed using a systematic review and meta-analysis. Subgroup analysis, sensitivity analysis, and publication bias analysis were also conducted.

RESULTS

A total of 32 studies were included in this meta-analysis. The overall meta-analysis results indicated that the pCR rate after NAT treatment in TNBC patients in the high TIL subgroup was significantly greater than that in patients in the low TIL subgroup (48.0% vs 27.7%) (risk ratio 2.01; 95% confidence interval 1.77-2.29; P < 0.001, I2 = 56%). Subgroup analysis revealed that the between-study heterogeneity originated from differences in study design, TIL level cutoffs, and study populations. Publication bias could have existed in the included studies. The meta-analysis based on different NAT protocols revealed that all TNBC patients with high levels of TILs had a greater rate of pCR after NAT treatment in all protocols (all P ≤ 0.01), and there was no significant between-protocol difference in the statistics among the different NAT protocols (P = 0.29). Additionally, sensitivity analysis demonstrated that the overall results of the meta-analysis remained consistent when the included studies were individually excluded.

CONCLUSION

TILs can serve as a predictor of the response to NAT treatment in TNBC patients. TNBC patients with high levels of TILs exhibit a greater NAT pCR rate than those with low levels of TILs, and this predictive capability is consistent across different NAT regimens.

Keywords: Breast cancer; Tumor-infiltrating lymphocyte; Neoadjuvant therapy; Treatment response; Systematic review; Meta-analysis

Core Tip: The immune response status may have a significant impact on the effectiveness of chemotherapy. Tumor-infiltrating lymphocytes (TILs) can directly or indirectly participate in specific immune responses against tumor cells. However, the association between TIL levels and the response to neoadjuvant therapy (NAT) in patients with triple-negative breast cancer (TNBC) remains unclear. This systematic review and meta-analysis first investigated the relationship between TIL status and the response to NAT in TNBC patients. This systematic review and meta-analysis will provide clinical physicians with systematic evidence on the role of TILs to predict the response of TNBC patients to NAT.