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Meta-Analysis
. 2022 Jul 18;22(1):782.
doi: 10.1186/s12885-022-09883-9.

Prognostic value of tumor-infiltrating lymphocytes in DCIS: a meta-analysis

Shuang-Ling Wu  1 , Xinmiao Yu  1 , Xiaoyun Mao  2 , Feng Jin  3
Affiliations
Meta-Analysis

Prognostic value of tumor-infiltrating lymphocytes in DCIS: a meta-analysis

Shuang-Ling Wu et al. BMC Cancer. .

Abstract

Background: Tumor infiltrating lymphocytes (TILs) have been shown to be associated with the prognosis of breast ductal carcinoma in situ (DCIS). In this systematic review and meta-analysis, we investigated the role of TILs and TIL subsets in predicting the recurrence risk of DCIS.

Method: PubMed, Medline, Web of Science, Embase and Cochrane were searched to identify publications investigating the prognostic role of TILs in DCIS. After study screening, data extraction and risk of bias assessment, a meta-analysis was performed to assess the association between TILs (total TILs, CD4+, CD8+, FOXP3+, PD-L1+ TILs) and the risk of DCIS recurrence.

Results: A pooled analysis indicated that dense stromal TILs in DCIS were associated with a higher recurrence risk (HR 2.11 (95% CI 1.35-3.28)). Subgroup analysis showed that touching TILs (HR 4.73 (95% CI 2.28-9.80)) was more precise than the TIL ratio (HR 1.49 (95% CI 1.11-1.99)) in estimating DCIS recurrence risk. Moreover, the prognostic value of TILs seemed more suitable for patients who are diagnosed with DCIS and then undergo surgery (HR 2.77, (95% CI 1.26-6.07)) or surgery accompanied by radiotherapy (HR 2.26, (95% CI 1.29-3.95)), than for patients who receive comprehensive adjuvant therapies (HR 1.16, (95% CI 1.35-3.28)). Among subsets of TILs, dense stromal PD-L1+ TILs were valuable in predicting higher recurrence risk of DCIS.

Conclusion: This systematic review and meta-analysis suggested a non-favorable prognosis of TILs and stromal PD-L1+ TILs in DCIS and indicated an appropriate assessment method for TILs and an eligible population.

Keywords: PD-L1; Tumor infiltrating lymphocytes (TILs); ductal carcinoma in situ (DCIS); prognosis; recurrence risk.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection and identification
Fig. 2
Fig. 2
Risk of bias assessment of included studies. A Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies; B Risk of bias summary: review authors’ judgments about each risk of bias item for each included study
Fig. 3
Fig. 3
Forest plots of the prognostic value of TILs in patients diagnosed with DCIS. A Forest plots of prognostic value of total TILs in DCIS; B Forest plots of prognostic value of TILs assessed with different strategies on recurrence risk of DCIS; C Forest plots of prognostic value of TILs on patients who receiving different therapies
Fig. 4
Fig. 4
Forest plots of the prognostic value of different subsets of T-TILs and PD-L1+ tumor cells in DICS
Fig. 5
Fig. 5
Sensitivity analysis of the meta-analysis of total TILs in DCIS
Fig. 6
Fig. 6
Funnel plots of potential publication bias with Egger’s test (A) and Begg’s test (B)
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