Abstract：
BACKGROUND: Cluster of differentiation 47 (CD47) has been identified as a new immune checkpoint. The exact role of CD47 in prognosis of breast cancer remains unclear. This study aims to evaluate immunohistochemical (IHC) expression of CD47 in breast cancer, and to measure the density of tumor associated macrophages (TAMs) infiltration by CD68 IHC staining. Furthermore, assessing the relations of CD47 and CD68 expression to different clinicopathological variables and evaluating the prognostic role of CD47 and CD68 in breast cancer cases.
METHODS: This retrospective cohort study included 200 diagnosed primary breast cancer cases who underwent surgical resection at the Oncology Center of Mansoura University (OCMU), Faculty of Medicine, Egypt. Clinicopathological and survival data were collected. IHC for CD47 and CD68 was performed.
RESULTS: Among 200 breast cancer cases, high CD47 expression was detected in 89 cases (44.5%). CD47 high expression was significantly associated with presence of distant metastasis (P=0.04), advanced TNM stage (P=0.02), ER & PR negativity (P=0.04 & 0.004 respectively), and molecular subtype (P=0.03). Their was a statistically significant association between CD47 and CD68 expression (P=0.002). CD47 high expression was found to predict poor overall survival, but it is not considered alone as independent poor prognostic factor by multivariate analysis. Multivariate analysis spotted combined high expression of CD47 and CD68 as an independent prognostic predictor for shorter OS in breast cancer patients (P=0.002).
CONCLUSIONS: CD47 high expression is related to poor prognosis in breast cancer patients especially when associated with high CD68+TAMs infiltration. Therefore, CD47 is a promising prognostic and therapeutic target in breast carcinoma that may direct selection of patients for immunotherapy.
METHODS: This retrospective cohort study included 200 diagnosed primary breast cancer cases who underwent surgical resection at the Oncology Center of Mansoura University (OCMU), Faculty of Medicine, Egypt. Clinicopathological and survival data were collected. IHC for CD47 and CD68 was performed.
RESULTS: Among 200 breast cancer cases, high CD47 expression was detected in 89 cases (44.5%). CD47 high expression was significantly associated with presence of distant metastasis (P=0.04), advanced TNM stage (P=0.02), ER & PR negativity (P=0.04 & 0.004 respectively), and molecular subtype (P=0.03). Their was a statistically significant association between CD47 and CD68 expression (P=0.002). CD47 high expression was found to predict poor overall survival, but it is not considered alone as independent poor prognostic factor by multivariate analysis. Multivariate analysis spotted combined high expression of CD47 and CD68 as an independent prognostic predictor for shorter OS in breast cancer patients (P=0.002).
CONCLUSIONS: CD47 high expression is related to poor prognosis in breast cancer patients especially when associated with high CD68+TAMs infiltration. Therefore, CD47 is a promising prognostic and therapeutic target in breast carcinoma that may direct selection of patients for immunotherapy.
摘要：
背景：分化簇47（CD47）已被鉴定为新的免疫检查点。CD47在乳腺癌预后中的确切作用尚不清楚。本研究旨在评估CD47在乳腺癌中的免疫组织化学(IHC)表达,并通过CD68IHC染色测量肿瘤相关巨噬细胞(TAMs)浸润的密度。此外，评估CD47和CD68表达与不同临床病理变量的关系，并评估CD47和CD68在乳腺癌病例中的预后作用。
方法：这项回顾性队列研究包括在Mansoura大学肿瘤学中心（OCMU）接受手术切除的200例确诊的原发性乳腺癌患者，医学院,埃及。收集临床病理和生存数据。进行CD47和CD68的IHC。
结果：在200例乳腺癌病例中，89例(44.5%)CD47高表达。CD47高表达与远处转移显著相关(P=0.04),高级TNM阶段（P=0.02），ER和PR的负性(P=0.04和0.004)，和分子亚型（P=0.03）。CD47和CD68表达之间存在统计学上的显著关联(P=0.002)。发现CD47高表达可预测总体生存率低，但多变量分析并不单独将其视为独立的不良预后因素.多因素分析发现，CD47和CD68的高表达可作为乳腺癌患者OS较短的独立预后预测因子(P=0.002)。
结论：CD47高表达与乳腺癌患者的不良预后相关，特别是当与高CD68+TAMs浸润相关时。因此,CD47是乳腺癌中一个有希望的预后和治疗靶点，可以指导患者的免疫治疗选择。
方法：这项回顾性队列研究包括在Mansoura大学肿瘤学中心（OCMU）接受手术切除的200例确诊的原发性乳腺癌患者，医学院,埃及。收集临床病理和生存数据。进行CD47和CD68的IHC。
结果：在200例乳腺癌病例中，89例(44.5%)CD47高表达。CD47高表达与远处转移显著相关(P=0.04),高级TNM阶段（P=0.02），ER和PR的负性(P=0.04和0.004)，和分子亚型（P=0.03）。CD47和CD68表达之间存在统计学上的显著关联(P=0.002)。发现CD47高表达可预测总体生存率低，但多变量分析并不单独将其视为独立的不良预后因素.多因素分析发现，CD47和CD68的高表达可作为乳腺癌患者OS较短的独立预后预测因子(P=0.002)。
结论：CD47高表达与乳腺癌患者的不良预后相关，特别是当与高CD68+TAMs浸润相关时。因此,CD47是乳腺癌中一个有希望的预后和治疗靶点，可以指导患者的免疫治疗选择。
