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Triple-negative breast cancer: the impact of guideline-adherent adjuvant treatment on survival—a retrospective multi-centre cohort study

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Abstract

Triple-negative breast cancer (TNBC) (ER−/PGR−/erb-2−) constitutes an aggressive subtype in breast cancer because it is accompanied by a significant decrease in overall survival (OAS) and recurrence-free survival (RFS) compared with hormone receptor positive breast cancers. This retrospective cohort study investigates the following issues: (1) Is there an impact of guideline-adherent treatment on RFS and OAS in TNBC? (2) Which adjuvant treatment has the most important impact on RFS and OAS in TNBC? This German retrospective multi-centre cohort study included 3,658 patients with primary breast cancer recruited from 2000 to 2005. The definition of guideline adherence was based on the German national S3 guideline for diagnosis and treatment of breast cancer (2004). A total of 371 patients (10.1%) had TNBC. Compared with HR+/erb-2− breast cancer (P = 0.001; HR = 1.75; 95% CI: 1.27–2.40), the recurrence rate of TNBC was significantly higher (P < 0.001; HR = 2.86; 95% CI: 2.17–3.76). Furthermore, the 5-year RFS and OAS was significantly lower in TNBC (RFS: 74.8% [95% CI: 68.8–80.8%] vs. 86.5% [95% CI: 84.6–88.4%] [log-rank P = 0.0001]) (OAS: 75.8% [95% CI: 69.9–81.8%] vs. 86.0% [95% CI: 84.1–87.9%] [log-rank P = 0.0001]). The most important parameters predicting RFS and OAS in TNBC after receiving guideline-conform chemotherapy are guideline-adherent surgery, radiotherapy, nodal status and grading. Overall, 66.8% TNBC were found with one or more (18%) guideline violations, which subsequently impaired OAS and RFS. The most important impact on OAS and RFS in TNBC patients was because of guideline violations (GV) concerning adjuvant radiotherapy and GV concerning adjuvant chemotherapy. Patients with TNBC primarily have a worse prognosis in terms of RFS and OAS than patients of a primarily non-TNBC phenotype. There is a strong association between guideline-adherent adjuvant treatment and improved survival outcome in TNBC. The outcome significantly decreases with the number of guideline violations.

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Acknowledgments

This study was supported by the German Federal Ministry of Education and Research (BMBF-Grant-01ZP0505). This study and the project BRENDA have been approved by the ethics committee of the University of Ulm. We gratefully thank the following people for their contributions to the BRENDA study: Karsten Gnauert (Ostalbklinikum, Aalen), Steffen Fritz (Kreisklinik Biberach), Ulf Göretzlehner (Kreiskrankenhaus Ehingen), Hans-Walter Vollert (Städt. Krankenhaus Friedrichshafen), Peter Jakob Albert (Klinikum Heidenheim), Ricardo Felberbaum (Klinikum Kempten), Andreas Zorr (Klinikum Konstanz), Felix Flock (Klinikum Memmingen), Erik Schlicht (Stauferklinik, Mutlangen), Martina Gropp-Meier (Oberschwabenklinik Ravensburg), Gerhard Bartzke (Kreiskrankenhaus Rottweil), Andreas Rempen (Diakonie-Krankenhaus, Schwäbisch Hall), Edgar Schelble (Kreiskrankenhaus Sigmaringen), Theodor Dinkelacker (Helfenstein-Klinik Geislingen), Andreas Grüneberger (Oberschwabenklinik Wangen) and Thorsten Kühn (Städt. Kliniken, Esslingen).

Conflict of interest

All authors declare that there are no potential conflicts of interest, including any financial, personal or other relationships with other people or organizations within that could inappropriately influence this work.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Ulm, Prittwitzstraße 43, 89075, Ulm, Germany

    L. Schwentner, R. Kreienberg & A. Wöckel

  2. Department of Mathematics and Computer Science, University Bremen, Universitätsallee, 28359, Bremen, Germany

    R. Wolters & M. B. Wischnewsky

  3. Department of Pathology, University Ulm, Albert-Einstein-Allee 23, 89070, Ulm, Germany

    K. Koretz & R. Rottscholl

Authors
  1. L. Schwentner
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  2. R. Wolters
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  3. K. Koretz
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  4. M. B. Wischnewsky
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  5. R. Kreienberg
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  6. R. Rottscholl
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  7. A. Wöckel
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Corresponding author

Correspondence to L. Schwentner.

Additional information

L. Schwentner and R. Wolters have contributed equally to this work.

This study was conducted on behalf of the BRENDA study group.

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Schwentner, L., Wolters, R., Koretz, K. et al. Triple-negative breast cancer: the impact of guideline-adherent adjuvant treatment on survival—a retrospective multi-centre cohort study. Breast Cancer Res Treat 132, 1073–1080 (2012). https://doi.org/10.1007/s10549-011-1935-y

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  • DOI: https://doi.org/10.1007/s10549-011-1935-y

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