1134 Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with poor prognosis. While immune infiltration and abundance have been established as prognostic indicators, we examine how immune spatial organization and tumor geometry jointly influence survival. Methods: Whole-slide H p = 0.03) and demonstrated clear Kaplan–Meier separation (log-rank p = 0.028). Increased tumor boundary complexity, measured by edge density normalized to tissue area, was also associated with poorer DSS (HR per SD = 1.77; p = 0.007). Kaplan–Meier analysis for edge density showed only modest separation (log-rank p = 0.071), consistent with a gradual, continuous risk effect rather than a discrete threshold. Similarly, greater intratumoral immune area correlated with adverse DSS (HR per SD = 1.26; p = 0.020), supporting the interpretation of intratumoral immune accumulation as a marker of ineffective or dysfunctional immune infiltration rather than protective immunity. In a multivariable Cox model, immune dispersion, tumor boundary complexity, and intratumoral immune area retained concordant effect directions and jointly achieved strong discrimination (C-index ≈ 0.74). Correlation analysis confirmed that the dominant spatial features were non-redundant, with minimal multicollinearity (all variance inflation factors < 1.2). Conclusions: In TNBC, survival is not solely dependent on immune abundance and proximity to the tumor region, but on the immune spatial dispersion, aggressive tumor boundaries, and ineffective immune accumulation in the intratumoral space. Novel spatial biomarkers examined here may refine risk stratification beyond conventional metrics.
Srivastava et al. (Wed,) studied this question.