Background: Triple negative breast cancer (TNBC) tends to present aggressively with
rapid progression and poor survival. Methods: We retrospectively
reviewed patients’ files to define TNBC patients’ characteristics, predictive
and prognostic factors, pattern of recurrence and survival. Results: 965
cases were identified. 147 patients (15.2%) were TNBC. 71.1% patients were
premenopausal. T2, T3, T4 tumors represented 46.1%, 32% and 14.1%,
respectively. N0, N1, N2, N3 disease represented 18.5%, 50.9%, 27.8% and 2.8%,
respectively. Stages II, III& IV
constituted 34.1%, 44.2% and 15.5%, respectively. 31.5% patients received
neoadjuvant chemotherapy with 17.7% complete pathological response. 19.5%,
35.9%, 44.6% patients had unknown, ≤20 and >20 Ki67, respectively. Among non-metastatic patients (n = 108), 21.3% patients developed relapse with
median time to relapse of 11 months. 78.3% of them had visceral (88.3% lung)
metastasis, 13% bone metastasis, 21.7% brain metastasis and 13% LRR. There is significantly high risk of relapse in patients with large tumor size [T4:
66.75%, T3: 22.9%, T2:
References
[1]
Gluz, O., Liedtke, C., Gottschalk, N., Pustzai, L., Nitz, U. and Harbeck, N. (2009) Triple-Negative Breast Cancer-Current Status and Future Directions. Annals of Oncology, 20, 1913-1927. https://doi.org/10.1093/annonc/mdp492
[2]
Rhee, J., Han, S.W., Oh, D.Y., Kim, J.H., Im, S.A., Han, W., Park, I.A., Noh, D.Y., Bang, Y.J. and Kim, T.Y. (2008) The Clinic Pathologic Characteristics and Prognostic Significance of Triple-Negativity in Node-Negative Breast Cancer. BMC Cancer, 8, 307-314. https://doi.org/10.1186/1471-2407-8-307
[3]
Voduc, K.D., Cheang, M., Tyldesley, T., Gelmon, K., Nielsen, T.O. and Kennecke, H. (2010) Breast Cancer Subtypes and the Risk of Local and Regional Relapse. Journal of Clinical Oncology, 28, 1684-1691.
https://doi.org/10.1200/JCO.2009.24.9284
[4]
Nishimura, R. and Arima, N. (2008) Is Triple Negative a Prognostic Factor in Breast Cancer? Breast Cancer, 15, 303-308. https://doi.org/10.1007/s12282-008-0042-3
[5]
Tian, X.S., Cong, M.H., Zhou, W.H., Zhu, J., Chen, Y.Z. and Liu, Q. (2008) Clinicopathological and Prognostic Characteristics of Triple-Negative Breast Cancer. Onkologie, 31, 610-614. https://doi.org/10.1159/000162288
[6]
Dawson, S.J., Provenzano, E., Caldas, C., et al. (2009) Triple Negative Breast Cancers: Clinical and Prognostic Implications. European Journal of Cancer, 45, 27-40.
https://doi.org/10.1016/S0959-8049(09)70013-9
[7]
Rakha, E.A., Elsheikh, S.E., Aleskandarany, M.A., et al. (2009) Triple-Negative Breast Cancer: Distinguishing between Basal and Non-Basal Subtypes. Clinical Cancer Research, 15, 2302-2310. https://doi.org/10.1158/1078-0432.CCR-08-2132
[8]
Podo, F., Buydens, L., Degani, H., et al. (2010) Triple-Negative Breast Cancer: Present Challenges and New Perspectives. Molecular Oncology, 4, 209-229.
https://doi.org/10.1016/j.molonc.2010.04.006
[9]
Wang, S.L., Li, Y.X., Song, Y.W., et al. (2011) Triple-Negative or HER2-Positive Status Predicts Higher Rates of Locoregional Recurrence in Node-Positive Breast Cancer Patients after Mastectomy. International Journal of Radiation Oncology, Biology, Physics, 80, 1095-1101. https://doi.org/10.1016/j.ijrobp.2010.03.038
[10]
Dent, R., Trudeau, M., Pritchard, K.I., et al. (2007) Triple-Negative Breast Cancer: Clinical Features and Patterns of Recurrence. Clinical Cancer Research, 13, 4429-4434. https://doi.org/10.1158/1078-0432.CCR-06-3045
[11]
Lin, N.U., Claus, E., Sohl, J., et al. (2008) Sites of Distant Recurrence and Clinical Outcomes in Patients with Metastatic Triple-Negative Breast Cancer: High Incidence of Central Nervous System Metastases. Cancer, 113, 2638-2645.
https://doi.org/10.1002/cncr.23930
[12]
Perou, C.M., Sorlie, T., Eisen, M.B., et al. (2000) Molecular Portraits of Human Breast Tumors. Nature, 406, 747-752. https://doi.org/10.1038/35021093
[13]
Sharma, D. and Singh, G. (2016) An Institutional Analysis of Clinicopathological Features of Triple Negative Breast Cancer. Indian Journal of Cancer, 53, 566-568.
https://doi.org/10.4103/ijc.IJC_534_16
[14]
Seshie, B., Adu-Aryee, N.A., Dedey, F., et al. (2015) A Retrospective Analysis of Breast Cancer Subtype Based on ER/PR and HER2 Status in Ghanaian Patients at the Korle Bu Teaching Hospital, Ghana. BMC Clinical Pathology, 15, Article No. 14. https://doi.org/10.1186/s12907-015-0014-4
[15]
Aghili, M., Lashkari, M., Farrokhpey, A.H., et al. (2013) Triple-Negative Breast Cancer Survival in Iranian Patients. Acta Medica Iranica, 51, 560-566.
[16]
Kassam, F., Enright, K., Dent, R., et al. (2009) Survival Outcomes for Patients with Metastatic Triple-Negative Breast Cancer: Implications for Clinical Practice and Trial Design. Clinical Breast Cancer, 9, 29-33.
https://doi.org/10.3816/CBC.2009.n.005
[17]
Carey, L.A., Perou, C.M., Livasy, C.A., et al. (2006) Race, Breast Cancer Subtypes, and Survival in the Carolina Breast Cancer Study. JAMA, 295, 2492-2502.
https://doi.org/10.1001/jama.295.21.2492
[18]
Stuart-Harris, R., et al. (2019) Recurrence in Early Breast Cancer: Analysis of Data from 3,765 Australian Women Treated between 1997 and 2015. Breast, 44, 153-159.
https://doi.org/10.1016/j.breast.2019.02.004
[19]
Ovcaricek, T., Frkovic, S.G., Matos, E., et al. (2011) Triple Negative Breast Cancer—Prognostic Factors and Survival. Radiology and Oncology, 45, 46-52.
https://doi.org/10.2478/v10019-010-0054-4
[20]
Nguyen, P.L., Taghian, A.G., Katz, M.S., et al. (2008) Breast Cancer Subtype Approximated by Estrogen Receptor, Progesterone Receptor, and HER-2 Is Associated with Local and Distant Recurrence after Breast Conserving Therapy. Journal of Clinical Oncology, 26, 2373-2378. https://doi.org/10.1200/JCO.2007.14.4287
[21]
Freedman, G.M., Anderson, P.R., Li, T., et al. (2009) Locoregional Recurrence of Triple-Negative Breast Cancer after Breast-Conserving Surgery and Radiation. Cancer, 11, 946-951. https://doi.org/10.1002/cncr.24094
[22]
Solin, L.J., Hwang, W., Vapiwala, N., et al. (2009) Outcome after Breast Conservation Treatment with Radiation for Women with Triple-Negative Early-Stage Invasive Breast Carcinoma. Clinical Breast Cancer, 9, 96-100.
https://doi.org/10.3816/CBC.2009.n.018
[23]
Haffty, B.G., Yang, Q., Reiss, M., Kearney, T., et al. (2006) Locoregional Relapse and Distant Metastasis in Conservatively Managed Triple Negative Early-Stage Breast Cancer. Journal of Clinical Oncology, 24, 5652-5657.
https://doi.org/10.1200/JCO.2006.06.5664
[24]
Abdulkarim, B.S., Cuartero, J., Hanson, J., et al. (2011) Increased Risk of Locoregional Recurrence for Women with T1-2N0 Triple-Negative Breast Cancer Treated with Modified Radical Mastectomy without Adjuvant Radiation Therapy Compared with Breast-Conserving Therapy. Journal of Clinical Oncology, 29, 1-8.
https://doi.org/10.1200/JCO.2010.33.4714
[25]
Zhu, X., Chen, L., Huang, B., et al. (2020) The Prognostic and Predictive Potential of Ki-67 in Triple-Negative Breast Cancer. Scientific Reports, 10, Article No. 225.
https://doi.org/10.1038/s41598-019-57094-3
[26]
Anders, C. and Carey, L. (2009) Biology, Metastatic Patterns, and Treatment of Patients with Triple-Negative Breast Cancer. Clinical Breast Cancer, 9, S73-S81.
https://doi.org/10.3816/CBC.2009.s.008
[27]
Kennecke, H., Yerushalmi, R., Woods, R., et al. (2010) Metastatic Behavior of Breast Cancer Subtypes. Journal of Clinical Oncology, 28, 3271-3277.
https://doi.org/10.1200/JCO.2009.25.9820
[28]
Foulkes, W.D., Smith, I.E. and Reis-Filho, J.S. (2010) Triple-Negative Breast Cancer. The New England Journal of Medicine, 363, 1938-1948.
https://doi.org/10.1056/NEJMra1001389
[29]
Yagata, H., Kajiura, Y., Yamauchi, H., et al. (2011) Current Strategy for Triple-Negative Breast Cancer: Appropriate Combination of Surgery, Radiation, and Chemotherapy. Breast Cancer, 18, 165-173. https://doi.org/10.1007/s12282-011-0254-9
[30]
Liedke, C., Mazouni, C., Hess, K.R., et al. (2008) Response to Neoadjuvant Therapy and Long-Term Survival in Patients with Triple-Negative Breast Cancer. Journal of Clinical Oncology, 26, 1275-1281. https://doi.org/10.1200/JCO.2007.14.4147
[31]
Peter, S., Javier, C., et al. (2020) Pembrolizumab for Early Triple-Negative Breast Cancer. The New England Journal of Medicine, 382, 810-821.
https://doi.org/10.1056/NEJMoa1910549
[32]
Wang, X., et al. (2021) Effect of Capecitabine Maintenance Therapy Using LowerDosage and Higher Frequency vs Observation on Disease-Free Survival among Patients with Early-Stage Triple-Negative Breast Cancer Who Had Received Standard Treatment the SYSUCC-001 Randomized Clinical Trial. JAMA, 325, 50-58.
https://doi.org/10.1001/jama.2020.23370
[33]
Iwata, H., Emens, L., Adams, S., et al. (2020) IMpassion130: Final OS Analysis from the Pivotal Phase III Study of Atezolizumab + Nab-Paclitaxel vs Placebo + Nab-Paclitaxel in Previously Untreated Locally Advanced or Metastatic Triple-Negative Breast Cancer. Annals of Oncology, 31, S1261-S1262. https://doi.org/10.1016/j.annonc.2020.10.069
[34]
Cortes, J., Cescon, D.W., Rugo, H.S., et al. (2020) Pembrolizumab plus Chemotherapy versus Placebo plus Chemotherapy for Previously Untreated Locally Recurrent Inoperable or Metastatic Triple-Negative Breast Cancer (KEYNOTE-355): A Randomised, Placebo-Controlled, Double-Blind, Phase 3 Clinical Trial. The Lancet, 396, 1817-1828.
[35]
Poggio, F., Bruzzone, M., Ceppi, M., et al. (2018) Platinum Based Neoadjuvant Chemotherapy in Triple Negative Breast Cancer: A Systematic Review and Meta-Analysis. Annals of Oncology, 29, 1497-1508.
https://doi.org/10.1093/annonc/mdy127
[36]
Loibl, S., Weber, K.E., Timms, K.M., et al. (2018) Survival Analysis of Carboplatin Added to an Anthracyclin/Taxanes Based Neoadjuvant Chemotherapy and HRD Score as Predictor of Response-Final Results from GeparSixto. Annals of Oncology, 29, 2341-2347. https://doi.org/10.1093/annonc/mdy460
[37]
Robson, M.E., Tung, N., Conte, P., et al. (2019) OlympiAD Final Overall Survival and Tolerability Results: Olaparib versus Chemotherapy Treatment of Physician’s Choice in Patients with a Germline BRCA Mutation and HER2-Negative Metastatic Breast Cancer. Annals of Oncology, 30, 558-566.
https://doi.org/10.1093/annonc/mdz012
