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This study investigated the prognostic relevance of immune cell subsets in irradiated patients. Node\u2010positive patients (\n                    <jats:italic>N<\/jats:italic>\n                    \u2009=\u20091307) from the Danish Breast Cancer Group internal mammary node (IMN)2 study were included, in which IMN irradiation (IMNI) was allocated by laterality. Tissue microarrays were stained with multiplex immunohistochemistry for CD8+, CD4+, and FOXP3+ T\u2010cells, CD68+ macrophages, and CD11c+\u2009dendritic cells. Digital image analysis quantified immune infiltration across spatial compartments. Prognostic associations with distant recurrence, breast cancer\u2010specific mortality, and overall mortality (OM) were assessed using multivariable flexible parametric survival models, including ER\u2010stratified analyses. T\u2010cell infiltration demonstrated a strong inverse association with OM, with 12\u2010year OM\u2010risk decreasing from 42% in tumors with lowest CD8+ infiltration to 27% in those with highest (HR 0.52, 95% CI (0.36\u20130.76)). The association was strongest in the ER\u2010negative subgroup. In ER\u2010positive disease, prognostic benefit was observed at low\u2010to\u2010moderate infiltration. CD68+ and CD11c+\u2009infiltration correlated with improved outcomes, but with weaker effects. Immune markers were not predictive of IMNI benefit. These findings demonstrate that T\u2010cell subsets are strong prognostic markers in irradiated BC patients, especially in ER\u2010negative disease.\n                  <\/jats:p>","DOI":"10.1111\/apm.70231","type":"journal-article","created":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T04:48:48Z","timestamp":1782449328000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Immune Cell Composition and Prognosis in Node\u2010Positive, Irradiated Breast Cancer Patients in the\n                    <scp>DBCG<\/scp>\n                    \u2010\n                    <scp>IMN2<\/scp>\n                    Study"],"prefix":"10.1111","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6537-0035","authenticated-orcid":false,"given":"Demet","family":"\u00d6zcan","sequence":"first","affiliation":[{"name":"Department of Pathology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders Winther M\u00f8lby","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7859-6321","authenticated-orcid":false,"given":"Patricia Switten","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Pathology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Alsner","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lise Bech Jellesmark","family":"Thorsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Oncology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Overgaard","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birgitte Vrou","family":"Offersen","sequence":"additional","affiliation":[{"name":"Department of Clinical Medicine Aarhus University  Aarhus Denmark"},{"name":"Department of Experimental Clinical Oncology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Oncology Aarhus University Hospital  Aarhus Denmark"},{"name":"Danish Center for Particle Therapy Aarhus University Hospital  Aarhus Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trine","family":"Tramm","sequence":"additional","affiliation":[{"name":"Department of Pathology Aarhus University Hospital  Aarhus Denmark"},{"name":"Department of Clinical Medicine Aarhus University  Aarhus 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