World Journal of Surgery

, Volume 40, Issue 6, pp 1362–1372 | Cite as

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

  • Gaurav Agarwal
  • Gitika Nanda
  • Punita Lal
  • Anjali Mishra
  • Amit Agarwal
  • Vinita Agrawal
  • Narendra Krishnani
Original Scientific Report



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.


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.


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.


Breast Cancer Overall Survival Breast Cancer Patient Infiltrate Ductal Carcinoma TNBC Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

268_2016_3422_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 33 kb)


  1. 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):2784–2795CrossRefPubMedPubMedCentralGoogle Scholar
  2. 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):1736–1747CrossRefPubMedPubMedCentralGoogle Scholar
  3. 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):191–196CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kaplan HG, Malmgren JA (2008) Impact of triple negative phenotype on breast cancer prognosis. Breast J 14(5):456–463CrossRefPubMedGoogle Scholar
  5. 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):2329–2334CrossRefPubMedGoogle Scholar
  6. 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):177–187CrossRefPubMedGoogle Scholar
  7. 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):5463–5472CrossRefPubMedPubMedCentralGoogle Scholar
  8. 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 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 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 CrossRefPubMedGoogle Scholar
  10. 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)Google Scholar
  11. 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):171–174CrossRefPubMedGoogle Scholar
  12. 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):56CrossRefGoogle Scholar
  13. 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):1663–1670CrossRefPubMedGoogle Scholar
  14. 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):2492–2502CrossRefPubMedGoogle Scholar
  15. 15.
    Millikan RC, Newman B, Tse CK et al (2008) Epidemiology of basal-like breast cancer. Breast Cancer Res Treat 109(1):123–139CrossRefPubMedPubMedCentralGoogle Scholar
  16. 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):1721–1728CrossRefPubMedGoogle Scholar
  17. 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):688–694CrossRefPubMedGoogle Scholar
  18. 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):68–75CrossRefPubMedGoogle Scholar
  19. 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):1554–1560CrossRefPubMedGoogle Scholar
  20. 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 91:2012–2017CrossRefPubMedPubMedCentralGoogle Scholar
  21. 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):127–136CrossRefPubMedGoogle Scholar
  22. 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):1275–1281CrossRefPubMedGoogle Scholar
  23. 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):10869–10874CrossRefPubMedPubMedCentralGoogle Scholar
  24. 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):7265–7277CrossRefPubMedGoogle Scholar
  25. 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):4–13CrossRefPubMedPubMedCentralGoogle Scholar
  26. 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):388CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2016

Authors and Affiliations

  1. 1.Department of Endocrine and Breast SurgerySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of Radiation OncologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  3. 3.Department of PathologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia

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