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

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.

Keywords

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.

Notes

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.

Supplementary material

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

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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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