Background:Although triple-negative breast cancer (TNBC) patients commonly receive adjuvant chemotherapy after surgery, their prognoses vary. This study aimed to investigate how the intrinsic subtypes of TNBCs and immune status of patients affect their prognosis.Methods:A total of 111 TNBC patients were retrospectively analyzed at Peking Union Medical College Hospital from 2002 to 2014. All underwent surgery and received adjuvant chemotherapy per NCCN guidelines. Intrinsic subtypes (luminal A, luminal B, HER2-enriched, and basal-like) were identified using PAM50 profiling. Recurrence-of-risk (ROR) scores were classified into high, intermediate, and low. Immune status was assessed via a 17-gene panel and categorized as immune-strong or immune-weak. Statistical analyses included chi-square tests, Kaplan–Meier curves, log-rank tests, and Cox regression.Results:All four PAM50 subtypes were present, with basal-like being the most common (77%). Luminal A patients with low-to-intermediate ROR scores showed worse outcomes than other subtypes (DFS,p= 0.123; OS,p= 0.170). Unexpectedly, high-ROR patients had the longest DFS (p= 0.042). Immune-strong status correlated with improved DFS and OS in stage IIB–III patients (DFS,p= 0.029; OS,p= 0.003), and was associated with higher TILs (p= 0.015) and PD-L1 expression on tumor cells (p= 0.022).Conclusions:Multigene-based assessment of molecular subtype and immune status provides important prognostic insight into TNBC and may guide adjuvant treatment decisions, particularly in non-basal-like subtypes.
背景：尽管三阴性乳腺癌（TNBC）患者术后通常接受辅助化疗，但其预后存在差异。本研究旨在探讨TNBC的内在亚型及患者免疫状态如何影响预后。 方法：回顾性分析北京协和医院2002年至2014年收治的111例TNBC患者。所有患者均接受手术治疗，并依据NCCN指南进行辅助化疗。采用PAM50分型法鉴定内在亚型（管腔A型、管腔B型、HER2富集型及基底样型），将复发风险评分分为高、中、低三级。通过17基因检测评估免疫状态，分为免疫强型与免疫弱型。统计分析包括卡方检验、Kaplan-Meier曲线、时序检验及Cox回归分析。 结果：四种PAM50亚型均存在，其中基底样型占比最高（77%）。具有中低复发风险评分的管腔A型患者预后较其他亚型更差（无病生存期，p=0.123；总生存期，p=0.170）。意外发现高复发风险评分患者无病生存期最长（p=0.042）。在IIB-III期患者中，免疫强型状态与改善的无病生存期和总生存期相关（无病生存期，p=0.029；总生存期，p=0.003），且与更高的肿瘤浸润淋巴细胞水平（p=0.015）及肿瘤细胞PD-L1表达（p=0.022）存在关联。 结论：基于多基因的分子亚型与免疫状态评估为TNBC预后提供了重要参考依据，可能指导辅助治疗决策，尤其对非基底样亚型具有临床指导价值。
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