Skip to main content
SpringerLink
Log in

Outcomes of Triple-Negative Breast Cancers (TNBC) Compared with Non-TNBC: Does the Survival Vary for All Stages?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Triple-negative breast cancer (TNBC) is associated with aggressive tumor behavior and worse outcomes. In a study at a tertiary care breast unit in a developing country, clinico-pathological attributes and outcomes of patients with TNBC were compared with (c.w.) ER, PR, and/or HER2 expressing tumors (non-TNBC).

Patients and methods

Medical records of 1213 consecutive breast cancer patients managed during 2004–2010 were reviewed. An evaluable cohort of 705 patients with complete treatment and follow-up (median 36 months) information was thus identified. Patients were categorized per ER, PR & HER2 status into TNBC, and ER/PR+ and/or HER2+ groups. Clinico-pathological parameters, response to NACT, and OS & DFS were compared between TNBC and non-TNBC groups.

Results

TNBC patients (n = 249) comprised 35.3 % of the study cohort (n = 705), and were significantly younger than non-TNBC patients (mean age 49.1 ± 11.2y c.w. 51.8 ± 11.3, p = 0.02). The TNM stage at presentation was similar in the two groups (Stage I and II—37 % c.w. 44.3 %, Stage III—47.5 % c.w. 39.5 %, Stage IV—15.5 % c.w. 16.2 % in TNBC c.w. Non-TNBC; p = 0.09). Tumor size (5.7 ± 2.9 cm TNBC c.w. 5.4 ± 2.8 cm non-TNBC, p = 0.22) was similar but lymph nodal (cN) metastases were more frequent in TNBC (77.3 % c.w. 69.8 %; p = 0.03). TNBC had higher histologic grade (97.1 % gr II/III in TNBC c.w. 91.2 % non-TNBC, p = 0.01) and higher incidence of LVI (20.4 % in TNBC c.w. 13.5 %, p = 0.03). Patient groups received similar multi-disciplinary surgical, radiation, and systemic treatment. Comparable proportion of patients in 2 groups were treated with NACT (42 % c.w. 38 %), which resulted in pathological complete response (pCR) in 27.5 % TNBC patients c.w. 17.1 % non-TNBC patients (p = 0.04). Both OS (81.8 ± 4.52 c.w. 97.90 ± 3.87 months, p < 0.001) and DFS (89.2 ± 5.1 c.w. 113.8 ± 4.3 months, p < 0.001) were shorter in TNBC than non-TNBC group. On stage-wise comparison, OS differed significantly only in stage III (47.4 ± 5.3 months in TNBC c.w. 74.5 ± 4.4 in non-TNBC; p < 0.001). Univariate and multivariate analyses revealed tumor stage and IHC subtyping into TNBC c.w. non-TNBC as most important factors predictive of survival.

Conclusions

TNBC occurred at younger age and exhibited aggressive pathology as compared to non-TNBC patients. Although patients with TNBC exhibited better chemo-sensitivity, they had worse DFS and OS compared to the non-TNBC patients. The survival of Stage III TNBC patients was significantly worse compared to non-TNBC group; while in stages I, II, and IV, survival were not significantly different.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Hammond ME, Hayes DF, Dowsett M et al (2010) American Society of Clinical Oncology/College Of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 28(16):2784–2795

    Article  PubMed  PubMed Central  Google Scholar 

  2. Goldhirsch A, Wood WC, Coates AS et al (2011) Strategies for subtypes-dealing with the diversity of breast cancer: highlights of the St. Gallen international expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol 22(8):1736–1747

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Hamm C, El-Masri M, Poliquin G et al (2011) A single-centre chart review exploring the adjusted association between breast cancer phenotype and prognosis. Curr Oncol 18(4):191–196

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kaplan HG, Malmgren JA (2008) Impact of triple negative phenotype on breast cancer prognosis. Breast J 14(5):456–463

    Article  PubMed  Google Scholar 

  5. Carey LA, Dees EC, Sawyer L et al (2007) The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 13(8):2329–2334

    Article  CAS  PubMed  Google Scholar 

  6. Lee JA, Kim KI, Bae JW et al (2010) Korean Breast Cancer Society. Triple negative breast cancer in Korea-distinct biology with different impact of prognostic factors on survival. Breast Cancer Res Treat 123(1):177–187

    Article  PubMed  Google Scholar 

  7. Lin NU, Vanderplas A, Hughes ME et al (2012) Clinicopathologic features, patterns of recurrence, and survival among women with triple-negative breast cancer in the National Comprehensive Cancer Network. Cancer 118(22):5463–5472

    Article  PubMed  PubMed Central  Google Scholar 

  8. Leong SP, Shen ZZ, Liu TJ et al (2010) Is breast cancer the same disease in Asian and Western countries? World J Surg 34(10):2308–2324. doi:10.1007/s00268-010-0683-1

    Article  PubMed  PubMed Central  Google Scholar 

  9. Agarwal G, Pradeep PV, Aggarwal V et al (2007) Spectrum of breast cancer in Asian women. World J Surg 31(5):1031–1040. doi:10.1007/s00268-005-0585-9

    Article  PubMed  Google Scholar 

  10. Ram Prabu MP, Raina V, Shukla NK et al (2011) A study of triple-negative breast cancer at a cancer institute in India. J Clin Oncol 29:(suppl; abstr e11548)

  11. Shet T, Agrawal A, Nadkarni M et al (2009) Hormone receptors over the last 8 years in a cancer referral center in India: what was and what is? Indian J Pathol Microbiol 52(2):171–174

    Article  PubMed  Google Scholar 

  12. Kuraparthy S, Reddy KM, Yadagiri LA et al (2007) Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India. World J Surg Oncol. 23(5):56

    Article  Google Scholar 

  13. Dey S, Boffetta P, Mathews A et al (2009) Risk factors according to estrogen receptor status of breast cancer patients in Trivandrum, South India. Int J Cancer 125(7):1663–1670

    Article  CAS  PubMed  Google Scholar 

  14. Carey LA, Perou CM, Livasy CA et al (2006) Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA 295(21):2492–2502

    Article  CAS  PubMed  Google Scholar 

  15. Millikan RC, Newman B, Tse CK et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109(1):123–139

    Article  PubMed  PubMed Central  Google Scholar 

  16. Bauer KR, Brown M, Cress RD et al (2007) Descriptive analysis of estrogen receptor (ER)-negative, progesterone receptor (PR)-negative, and HER2-negative invasive breast cancer, the so-called triple-negative phenotype: a population-based study from the California cancer Registry. Cancer 109(9):1721–1728

    Article  PubMed  Google Scholar 

  17. Matos I, Dufloth R, Alvarenga M et al (2005) p63, cytokeratin 5 and P-cadherin: three molecular markers to distinguish basal phenotype in breast carcinomas. Virchows Arch 447(4):688–694

    Article  CAS  PubMed  Google Scholar 

  18. Elnashar AT, Ali el-SM, Gaber A (2012) The prognostic value of triple negative in stage II/III breast cancer. J Oncol Pharm Pract. 18(1):68–75

    Article  PubMed  Google Scholar 

  19. Park YH, Lee SJ, Cho EY et al (2011) Clinical relevance of TNM staging system according to breast cancer subtypes. Ann Oncol 22(7):1554–1560

    Article  CAS  PubMed  Google Scholar 

  20. Ring AE, Smith IE, Ashley S et al (2004) Oestrogen receptor status, pathological complete response and prognosis in patients receiving neoadjuvant chemotherapy for early breast cancer. Brit J Cancer 91:2012–2017

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Martin M, Romero A, Cheang MC et al (2011) Genomic predictors of response to doxorubicin versus docetaxel in primary breast cancer. Breast Cancer Res Treat 128(1):127–136

    Article  CAS  PubMed  Google Scholar 

  22. Liedtke C, Mazouni C, Hess KR et al (2008) Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol 26(8):1275–1281

    Article  PubMed  Google Scholar 

  23. Sørlie T, Perou CM, Tibshirani R et al (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98(19):10869–10874

    Article  PubMed  PubMed Central  Google Scholar 

  24. Gianni L, Zambetti M, Clark K et al (2005) Gene expression profiles in paraffin-embedded core biopsy tissue predict response to chemotherapy in women with locally advanced breast cancer. J Clin Oncol 23(29):7265–7277

    Article  CAS  PubMed  Google Scholar 

  25. Onitilo AA, Engel JM, Greenlee RT, Mukesh BN (2009) Breast cancer subtypes based on ER/PR and Her2 expression: comparison of clinicopathologic features and survival. Clin Med Res. 7(1–2):4–13

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Pogoda K, Niwikska A, Murawska M, Pieńkowski T (2013) Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol 30(1):388

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors are grateful to faculty and resident doctors of the Departments of Endocrine and Breast surgery; Radiation oncology; and Pathology at SGPGIMS Lucknow for their help with data retrieval and analysis, and with review of clinical and pathology data and material.

Author information

Author notes

    Authors and Affiliations

    1. Department of Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

      Gaurav Agarwal, Gitika Nanda, Anjali Mishra & Amit Agarwal

    2. Department of Radiation Oncology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

      Punita Lal

    3. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

      Vinita Agrawal & Narendra Krishnani

    Authors
    1. Gaurav Agarwal
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Gitika Nanda
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Punita Lal
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Anjali Mishra
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Amit Agarwal
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Vinita Agrawal
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Narendra Krishnani
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Gaurav Agarwal.

    Additional information

    Gaurav Agarwal and Gitika Nanda have contributed equally and are joint first authors.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary material 1 (DOCX 33 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Agarwal, G., Nanda, G., Lal, P. et al. Outcomes of Triple-Negative Breast Cancers (TNBC) Compared with Non-TNBC: Does the Survival Vary for All Stages?. World J Surg 40, 1362–1372 (2016). https://doi.org/10.1007/s00268-016-3422-4

    Download citation

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00268-016-3422-4

    Keywords

    Search

    Navigation