This narrative review aims to clarify the role of tertiary lymphoid structures in breast cancer. We examine their development, composition, and prognostic value, and current ways of recognizing them. A comprehensive literature review was performed using the PubMed/Medline, Scopus, and EMBASE databases. A significant area of interest in breast cancer research involves targeting immune checkpoint molecules, particularly in the triple-negative subtype, where treatment options remain limited. However, existing biomarkers have limitations in accurately predicting treatment response. In this context, tertiary lymphoid structures (TLSs) emerge as a prognostic biomarker and also as a promising predictive marker for response. TLSs are ectopic lymphoid formations or neo-organogenesis that can develop after prolonged exposure to inflammatory signals mediated by chemokines and cytokines. Their presence is inversely correlated with estrogen receptor (ER) and/or progesterone receptor (PR) expression, but positively associated with a higher pathologic complete response rate and improved overall survival. In certain scenarios, TLS-positive tumors were associated with improved outcomes regardless of the presence of PDL-1 (programmed cell death ligand 1) expression or TILs (tumor-infiltrating lymphocytes).
本叙述性综述旨在阐明三级淋巴结构在乳腺癌中的作用。我们系统考察了其形成机制、组成成分、预后价值及当前识别方法。通过检索PubMed/Medline、Scopus和EMBASE数据库进行了全面文献综述。乳腺癌研究的重要领域涉及靶向免疫检查点分子，特别是在治疗选择有限的三阴性亚型中。然而，现有生物标志物在准确预测治疗反应方面存在局限。在此背景下，三级淋巴结构不仅作为预后生物标志物，更成为极具潜力的治疗反应预测指标。三级淋巴结构是在趋化因子和细胞因子介导的慢性炎症信号刺激下形成的异位淋巴组织或新生淋巴器官。其存在与雌激素受体和/或孕激素受体表达呈负相关，但与更高的病理完全缓解率和改善的总生存期呈正相关。在某些情况下，无论程序性死亡配体1表达或肿瘤浸润淋巴细胞存在与否，三级淋巴结构阳性肿瘤均与良好预后相关。
The Emerging Role of Tertiary Lymphoid Structures in Breast Cancer: A Narrative Review
肿瘤(癌症)患者之家