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table_1_High Densities of Tumor-Associated Plasma Cells Predict Improved Prognosis in Triple Negative Breast Cancer.docx
<p>Breast cancer is the most common malignancy affecting women, but the heterogeneity of the condition is a significant obstacle to effective treatment. Triple negative breast cancers (TNBCs) do not express HER2 or the receptors for estrogen or progesterone, and so often have a poor prognosis. Tumor-infiltrating T cells have been well-characterized in TNBC, and increased numbers are associated with better outcomes; however, the potential roles of B cells and plasma cells have been large. Here, we conducted a retrospective correlative study on the expression of B cell/plasma cell-related genes, and the abundance and localization of B cells and plasma cells within TNBCs, and clinical outcome. We analyzed 269 TNBC samples and used immunohistochemistry to quantify tumor-infiltrating B cells and plasma cells, coupled with NanoString measurement of expression of immunoglobulin metagenes. Multivariate analysis revealed that patients bearing TNBCs with above-median densities of CD38<sup>+</sup> plasma cells had significantly better disease-free survival (DFS) (HRβ=β0.44; 95% CI 0.26β0.77; pβ=β0.004) but not overall survival (OS), after adjusting for the effects of known prognostic factors. In contrast, TNBCs with higher immunoglobulin gene expression exhibited improved prognosis (OS pβ=β0.029 and DFS pβ=β0.005). The presence of B cells and plasma cells was positively correlated (pβ<β0.0001, Rβ=β0.558), while immunoglobulin gene IGKC, IGHM, and IGHG1 mRNA expression correlated specifically with the density of CD38<sup>+</sup> plasma cells (IGKC pβ<β0.0001, Rβ=β0.647; IGHM pβ<β0.0001, Rβ=β0.580; IGHG1 pβ<β0.0001, Rβ=β0.655). Interestingly, after adjusting the multivariate analysis for the effect of intratumoral CD38<sup>+</sup> plasma cell density, the expression levels of all three genes lost significant prognostic value, suggesting a biologically important role of plasma cells. Last but not least, the addition of intratumoral CD38<sup>+</sup> plasma cell density to clinicopathological features significantly increased the prognostic value for both DFS (ΞLRΟ<sup>2</sup>β=β17.28, pβ=β1.71Eβ08) and OS (ΞLRΟ<sup>2</sup>β=β10.03, pβ=β6.32Eβ08), compared to clinicopathological features alone. The best combination was achieved by integrating intratumoral CD38<sup>+</sup> plasma cell density and IGHG1 which conferred the best added prognostic value for DFS (ΞLRΟ<sup>2</sup>β=β27.38, pβ=β5.22Eβ10) and OS (ΞLRΟ<sup>2</sup>β=β21.29, pβ=β1.03Eβ08). Our results demonstrate that the role of plasma cells in TNBC warrants further study to elucidate the relationship between their infiltration of tumors and disease recurrence.</p