Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of Local and Distant Recurrence Patterns in Patients with Triple-Negative Breast Cancer According to Age

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Triple-negative breast cancer (TNBC) subtype and young patient age are both associated with an increased risk of local recurrence (LR) and distant recurrence (DR). In young women with TNBC, it is unclear whether subtype or patient age is driving prognosis.

Methods

Patients treated for primary TNBC from 1998 to 2011 were identified from the breast surgery database. Clinicopathologic characteristics, treatment, and outcomes were compared between patients <40 and ≥40 years of age at diagnosis. Multivariate models were used to identify factors independently associated with LR and DR.

Results

Among 1930 patients with TNBC, 289 (15 %) were <40 and 1641 (85 %) were ≥40 years of age at diagnosis. Younger patients were more likely to present with higher stage disease and more likely to receive mastectomy (p < 0.01), axillary node dissection (p < 0.01), and chemotherapy (p < 0.01). At a median follow-up of 74 (0–201.1) months, there was no difference in LR or disease-free survival (DFS) by age group [5-year LR = 3.9 % (95 % confidence interval (CI) 1.5–6.2) vs. 4.5 % (95 % CI 3.5–5.6) and 5-year DFS = 75.3 % (95 % CI 70.2–80.7) vs. 77.7 % (95 % CI 75.6–79.8), p = 0.94] in patients aged <40 and ≥40 years, respectively. On multivariate analysis, larger tumor size, lymphovascular invasion, and nodal positivity were associated with increased risk of DR. Age and type of surgery were not significantly associated with either outcome.

Conclusions

Young age at diagnosis is not an independent risk factor for LR or DR in patients with TNBC.

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

Similar content being viewed by others

References

  1. Sidoni A, Cavaliere A, Bellezza G, Scheibel M, Bucciarelli E. Breast cancer in young women: clinicopathological features and biological specificity. Breast. 2003;12:247–50.

    Article  CAS  PubMed  Google Scholar 

  2. Li ZH, Xiong QY, Tu JH, et al. Tau proteins expressions in advanced breast cancer and its significance in taxane-containing neoadjuvant chemotherapy. Med Oncol. 2013;30:591.

    Article  PubMed  Google Scholar 

  3. Collins LC, Marotti JD, Gelber S, et al. Pathologic features and molecular phenotype by patient age in a large cohort of young women with breast cancer. Breast Cancer Res Treat. 2012;131:1061–6.

    Article  CAS  PubMed  Google Scholar 

  4. Xiong Q, Valero V, Kau V, et al. Female patients with breast carcinoma age 30 years and younger have a poor prognosis: the MD Anderson Cancer Center experience. Cancer. 2001;92:2523–8.

    Article  CAS  PubMed  Google Scholar 

  5. Dent R, Trudeau M, Pritchard KI, et al. Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res. 2007;13:4429–34.

    Article  PubMed  Google Scholar 

  6. Wang SL, Li YX, Song YW, et al. Triple-negative or HER2-positive status predicts higher rates of locoregional recurrence in node-positive breast cancer patients after mastectomy. Int J Radiat Oncol Biol Phys. 2011;80:1095–101.

    Article  PubMed  Google Scholar 

  7. Montagna E, Maisonneuve P, Rotmensz N, et al. Heterogeneity of triple-negative breast cancer: histologic subtyping to inform the outcome. Clin Breast Cancer. 2013;13:31–9.

    Article  PubMed  Google Scholar 

  8. Pilewskie M, King TA. Age and molecular subtypes: impact on surgical decisions. J Surg Oncol. 2014;110:8–14.

    Article  PubMed  Google Scholar 

  9. Kim EK, Noh WC, Han W, Noh DY. Prognostic significance of young age (<35 years) by subtype based on ER, PR, and HER2 status in breast cancer: a nationwide registry-based study. World J Surg. 2011;35:1244–53.

    Article  PubMed  Google Scholar 

  10. Liedtke C, Hess KR, Karn T, et al. The prognostic impact of age in patients with triple-negative breast cancer. Breast Cancer Res Treat. 2013;138:591–9.

    Article  PubMed  Google Scholar 

  11. Ahn SH, Son BH, Kim SW, et al. Poor outcome of hormone receptor–positive breast cancer at very young age is due to tamoxifen resistance: nationwide survival data in Korea—a report from the Korean Breast Cancer Society. J Clin Oncol. 2007;25:2360–8.

    Article  PubMed  Google Scholar 

  12. Partridge AH, Hughes ME, Warner ET, et al. Subtype-dependent relationship between young age at diagnosis and breast cancer survival. J Clin Oncol. 2016;34:3308–14.

    Article  PubMed  Google Scholar 

  13. Sheridan W, Scott T, Caroline S, et al. Breast cancer in young women: have the prognostic implications of breast cancer subtypes changed over time? Breast Cancer Res Treat. 2014;147:617–29.

    Article  PubMed  Google Scholar 

  14. King TA, Pilewskie M, Morrow M. Optimal surgical management for high-risk populations. Breast. 2015;24(suppl 2):S91–5.

    Article  PubMed  Google Scholar 

  15. Cancello G, Maisonneuve P, Rotmensz N, et al. Prognosis in women with small (T1mic,T1a,T1b) node-negative operable breast cancer by immunohistochemically selected subtypes. Breast Cancer Res Treat. 2011;127:713–20.

    Article  CAS  PubMed  Google Scholar 

  16. Gangi A, Chung A, Mirocha J, Liou DZ, Leong T, Giuliano AE. Breast-conserving therapy for triple-negative breast cancer. JAMA Surg. 2014;149:252–8.

    Article  PubMed  Google Scholar 

  17. Lowery AJ, Kell MR, Glynn RW, Kerin MJ, Sweeney KJ. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat. 2012;133:831–41.

    Article  PubMed  Google Scholar 

  18. Fisher B, Dignam J, Bryant J, et al. Five versus more than five years of tamoxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor–positive tumors. J Natl Cancer Inst. 1996;88:1529–42.

    Article  CAS  PubMed  Google Scholar 

  19. Dahabreh IJ, Linardou H, Siannis F, Fountzilas G, Murray S. Trastuzumab in the adjuvant treatment of early-stage breast cancer: a systematic review and meta-analysis of randomized controlled trials. Oncologist. 2008;13:620–30.

    Article  CAS  PubMed  Google Scholar 

  20. Kiess AP, McArthur HL, Mahoney K, et al. Adjuvant trastuzumab reduces locoregional recurrence in women who receive breast-conservation therapy for lymph node-negative, human epidermal growth factor receptor 2–positive breast cancer. Cancer. 2012;118:1982–8.

    Article  CAS  PubMed  Google Scholar 

  21. Abdulkarim BS, Cuartero J, Hanson J, Deschenes J, Lesniak D, Sabri S. 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. J Clin Oncol. 2011;29:2852–8.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Adkins FC, Gonzalez-Angulo AM, Lei X, et al. Triple-negative breast cancer is not a contraindication for breast conservation. Ann Surg Oncol. 2011;18:3164–73.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Zumsteg ZS, Morrow M, Arnold B, et al. Breast-conserving therapy achieves locoregional outcomes comparable to mastectomy in women with T1–2N0 triple-negative breast cancer. Ann Surg Oncol. 2013;20:3469–76.

    Article  PubMed  Google Scholar 

  24. Pilewskie M, Ho A, Orell E, et al. Effect of margin width on local recurrence in triple-negative breast cancer patients treated with breast-conserving therapy. Ann Surg Oncol. 2014;21:1209–14.

    Article  PubMed  Google Scholar 

  25. van Laar C, van der Sangen MJ, Poortmans PM, et al. Local recurrence following breast-conserving treatment in women aged 40 years or younger: trends in risk and the impact on prognosis in a population-based cohort of 1143 patients. Eur J Cancer. 2013;49:3093–101.

    Article  PubMed  Google Scholar 

  26. Coulombe G, Tyldesley S, Speers C, et al. Is mastectomy superior to breast-conserving treatment for young women? Int J Radiat Oncol Biol Phys. 2007;67:1282–90.

    Article  PubMed  Google Scholar 

  27. Kroman N, Holtveg H, Wohlfahrt J, et al. Effect of breast-conserving therapy versus radical mastectomy on prognosis for young women with breast carcinoma. Cancer. 2004;100:688–93.

    Article  PubMed  Google Scholar 

  28. Da Silva L, Lakhani SR. Pathology of hereditary breast cancer. Mod Pathol. 2010;23(suppl 2):S46–51.

    Article  PubMed  Google Scholar 

  29. Boyle P. Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol. 2012;23(suppl 6):vi7–12.

    Article  PubMed  Google Scholar 

  30. Greenup R, Buchanan A, Lorizio W, et al. Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort. Ann Surg Oncol. 2013;20:3254–8.

    Article  PubMed  Google Scholar 

  31. Valachis A, Nearchou AD, Lind P. Surgical management of breast cancer in BRCA-mutation carriers: a systematic review and meta-analysis. Breast Cancer Res Treat. 2014;144:443–55.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

Partly funded by a Grant provided by the German academic exchange services (DAAD; Grant No. 91533303 to J.C.R.).

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Julia C. Radosa MD, Michelle Stempel MPH, Amrin Khander MD, Maria Karsten MD, Melissa Pilewskie MD, Monica Morrow MD & Tari A. King MD

  2. Department of Gynecology and Obstetrics, Saarland University Hospital, Homburg, Germany

    Julia C. Radosa MD & Erich-Franz Solomayer PhD

  3. Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Anne Eaton MS

  4. Department of Gynecology and Obstetrics, University of Schleswig-Holstein, Lübeck, Germany

    Cornelia Liedtke PhD

  5. Breast Surgery, Brigham and Women’s Hospital, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA, USA

    Tari A. King MD

Authors
  1. Julia C. Radosa MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne Eaton MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michelle Stempel MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amrin Khander MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cornelia Liedtke PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erich-Franz Solomayer PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Maria Karsten MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Melissa Pilewskie MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Monica Morrow MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tari A. King MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tari A. King MD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Radosa, J.C., Eaton, A., Stempel, M. et al. Evaluation of Local and Distant Recurrence Patterns in Patients with Triple-Negative Breast Cancer According to Age. Ann Surg Oncol 24, 698–704 (2017). https://doi.org/10.1245/s10434-016-5631-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5631-3

Keywords

Search

Navigation