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Open Access Highly Accessed Research article

The presence of tumor associated macrophages in tumor stroma as a prognostic marker for breast cancer patients

Catharina Medrek1*, Fredrik Pontén2, Karin Jirström3 and Karin Leandersson1

Author Affiliations

1 Center for Molecular Pathology, Jan Waldenströmsgata 59, Skåne University Hospital, Lund University, 20502, Malmö, Sweden

2 Department of Genetics and Pathology, Rudbeck Laboratory, Uppsala University, 751 85, Uppsala, Sweden

3 Department of Clinical Sciences, Pathology, Skåne University Hospital, Lund University, 221 85, Lund, Sweden

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BMC Cancer 2012, 12:306  doi:10.1186/1471-2407-12-306

Published: 23 July 2012

Abstract

Background

Tumor associated macrophages (TAMs) are alternatively activated macrophages that enhance tumor progression by promoting tumor cell invasion, migration and angiogenesis. TAMs have an anti-inflammatory function resembling M2 macrophages. CD163 is regarded as a highly specific monocyte/macrophage marker for M2 macrophages. In this study we evaluated the specificity of using the M2 macrophage marker CD163 as a TAM marker and compared its prognostic value with the more frequently used pan-macrophage marker CD68. We also analyzed the prognostic value of the localization of CD163+ and CD68+ myeloid cells in human breast cancer.

Methods

The extent of infiltrating CD163+ or CD68+ myeloid cells in tumor nest versus tumor stroma was evaluated by immunohistochemistry in tissue microarrays with tumors from 144 breast cancer cases. Spearman’s Rho and χ2 tests were used to examine the correlations between CD163+ or CD68+ myeloid cells and clinicopathological parameters. Kaplan Meier analysis and Cox proportional hazards modeling were used to assess the impact of CD163+ and CD68+ myeloid cells in tumor stroma and tumor nest, respectively, on recurrence free survival, breast cancer specific and overall survival.

Results

We found that infiltration of CD163+ and CD68+ macrophages into tumor stroma, but not into tumor nest, were of clinical relevance. CD163+ macrophages in tumor stroma positively correlated with higher grade, larger tumor size, Ki67 positivity, estrogen receptor negativity, progesterone receptor negativity, triple-negative/basal-like breast cancer and inversely correlated with luminal A breast cancer. Some CD163+ areas lacked CD68 expression, suggesting that CD163 could be used as a general anti-inflammatory myeloid marker with prognostic impact. CD68+ macrophages in tumor stroma positively correlated to tumor size and inversely correlated to luminal A breast cancer. More importantly, CD68 in tumor stroma was an independent prognostic factor for reduced breast cancer specific survival.

Conclusion

These findings highlight the importance of analyzing the localization rather than merely the presence of TAMs as a prognostic marker for breast cancer patients.

Keywords:
Tumor associated macrophages; Tumor stroma; CD163; CD68