Significance of Histomorphology of Early Triple-Negative Breast Cancer
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Triple-negative breast cancer (TNBC) is a heterogeneous disease. Possibly genetic characterisation provides the most appropriate information on tumour biology and prognosis, but it is only limitedly available in clinical practice. The aim of this investigation was to explore what additional prognostic information could be gained from detailed histomorphologic report. Patients and method: patients were selected retrospectively operated from 2005 to 2009 in one institution and charts were revised. Beyond age, tumour and nodal status, histologic grade and therapy, the additional pathologic characteristics were also involved in analysis: necrosis, lymphocytic infiltration, peritumoural vascular invasion (PVI), perineural invasion, DCIS extent and grade, perinodal spread, mitotic activity index (MAI). Results: 295 early TNBC were involved. In univariate survival analysis with a mean follow-up of 3.57 years the tumour size, the nodal status, type of operation (conservation or mastectomy), irradiation, PVI and perinodal spread proved to be significantly connected with both disease free survival (DFS) and breast cancer specific overall survival (BSOS), and necrosis and chemotherapy with BSOS. Necrosis analysed together with lymphocytic infiltrate showed greater predicting power. In multivariate analysis nodal metastasis, necrosis positive/lymphacytic infiltration negative status and lack of irradiation has significant negative impact on DFS (p = <0.0001 HR:1.98 [1.4–2.77], p = <0.017 HR:2.1 [1.1–3.8], p = <0.001 HR:0.25 [0.11–0.57], respectively) and BSOS (p = <0.0001 HR:2.47 [1.8–3.4], p = <0.017 HR:3.7 [1.6–8.2], p = <0.0017 HR:0.24 [0.1–0.58], respectively). For DFS perivascular invasion also showed significant effect (p = <0.042 HR:2.5 [1.0–6.0]). Nodal status was the strongest prognostic parameter but other histomorphologic parameters can be used for prognosis prediction.
KeywordsTriple-negative breast cancer Vascular invasion Necrosis Irradiation
We are grateful to statistician Istvan Gaudi for his unlimited support in statistical analysis and to Monika Nagy and Tibor Radovics for their help in data acquisition.
- 8.Viale G, Giobbie-Hurder A, Gusterson BA, Maiorano E, Mastropasqua MG, Sonzogni A, Mallon E, Colleoni M, Castiglione-Gertsch M, Regan MM, Price KN, Brown RW, Golouh R, Crivellari D, Karlsson P, Ohlschlegel C, Gelber RD, Goldhirsch A, Coates AS (2010) Adverse prognostic value of peritumoral vascular invasion: is it abrogated by adequate endocrine adjuvant therapy? Results from two International Breast Cancer Study Group randomized trials of chemoendocrine adjuvant therapy for early breast cancer. Ann Oncol 21:245–254PubMedCrossRefGoogle Scholar
- 11.Lende TH, Janssen EA, Gudlaugsson E, Voorhorst F, Smaaland R, van Diest P, Søiland H, Baak JP (2011) In patients younger than age 55 years with lymph node-negative breast cancer, proliferation by mitotic activity index is prognostically superior to adjuvant! J Clin Oncol 29:852–858PubMedCrossRefGoogle Scholar
- 15.Wolff AC, Hammond ME, Schwartz JN, Hagerty KL, Allred DC, Cote RJ, Dowsett M, Fitzgibbons PL, Hanna WM, Langer A, McShane LM, Paik S, Pegram MD, Perez EA, Press MF, Rhodes A, Sturgeon C, Taube SE, Tubbs R, Vance GH, van de Vijver M, Wheeler TM, Hayes DF (2007) American Society of Clinical Oncology; College of American Pathologists. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. J Clin Oncol 25:118–145PubMedCrossRefGoogle Scholar
- 19.Bauer KR, Brown M, Cress RD et al (2007) Descripitive analysis of estrogen receptor (ER)-negative, progesteron 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 109:1721–1728PubMedCrossRefGoogle Scholar
- 25.Linderholm BK, Hellborg H, Johansson U, Elmberger G, Skoog L, Lehtiö J, Lewensohn R (2009) Significantly higher levels of vascular endothelial growth factor (VEGF) and shorter survival times for patients with primary operable triple-negative breast cancer. Ann Oncol 20:1639–1646PubMedCrossRefGoogle Scholar
- 27.Colleoni M, Rotmensz N, Maisonneuve P, Sonzogni A, Pruneri G, Casadio C, Luini A, Veronesi P, Intra M, Galimberti V, Torrisi R, Andrighetto S, Ghisini R, Goldhirsch A, Viale G (2007) Prognostic role of the extent of peritumoral vascular invasion in operable breast cancer. Ann Oncol 18:1632–1640PubMedCrossRefGoogle Scholar
- 30.Viale G, Regan MM, Maiorano E, Mastropasqua MG, Dell’Orto P, Rasmussen BB, Raffoul J, Neven P, Orosz Z, Braye S, Ohlschlegel C, Thürlimann B, Gelber RD, Castiglione-Gertsch M, Price KN, Goldhirsch A, Gusterson BA, Coates AS (2007) Prognostic and predictive value of centrally reviewed expression of estrogen and progesterone receptors in a randomized trial comparing letrozole and tamoxifen adjuvant therapy for postmenopausal early breast cancer: BIG 1–98. J Clin Oncol 25:3846–3852PubMedCrossRefGoogle Scholar
- 32.Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, Hicks DG, Lester S, Love R, Mangu PB, McShane L, Miller K, Osborne CK, Paik S, Perlmutter J, Rhodes A, Sasano H, Schwartz JN, Sweep FC, Taube S, Torlakovic EE, Valenstein P, Viale G, Visscher D, Wheeler T, Williams RB, Wittliff JL, Wolff AC (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 28:2784–2795PubMedCrossRefGoogle Scholar