Differences in the immune response of the non-metastatic axillary lymph nodes between triple-negative and luminal A breast cancer surrogate subtypes

Abstract Breast cancer (BC) comprises four immunohistochemical surrogate subtypes, of which triple-negative breast cancer (TNBC) has the highest risk of mortality. Axillary lymph nodes (ALNs) are the regions where BC cells first establish before distant metastasis, and the presence of tumor cells in the ALN gives rise to an immune tolerance profile that contrasts with that of the non-metastatic ALN (ALN-). However, few studies have compared the immune components of the ALNs- in BC subtypes. The present study aimed to determine whether differences between immune populations in the primary tumor and ALNs- were associated with the luminal A or TNBC subtype. We evaluated a retrospective cohort of 144 patients using paraffin-embedded biopsies. TNBC samples tended to have a higher histological grade and proliferation index, and had higher levels of immune markers compared with luminal A in primary tumors and ALNs-. Two methods for validating the multivariate analysis showed that histological grade, intratumoral S100 dendritic cells, and CD8 T lymphocytes and CD57 Natural Killers in the ALNs- were factors associated with TNBC, while CD83 dendritic cells in the ALNs- were associated with luminal A. In conclusion, we found that intratumoral regions and ALNs- of TNBC contained higher concentrations of markers related to immune tolerance than did Luminal A. This partially explains the worse prognosis of TNBC.