Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :836
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
 »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »  Article in PDF (307 KB)
 »  Citation Manager
 »  Access Statistics
 »  Reader Comments
 »  Email Alert *
 »  Add to My List *
* Registration required (free)  

 
  In this article
 »  Abstract
 » Introduction
 »  Materials and Me...
 » Results
 » Discussion
 » Conclusion
 »  References
 »  Article Figures
 »  Article Tables

 Article Access Statistics
    Viewed1082    
    Printed13    
    Emailed0    
    PDF Downloaded199    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 53  |  Issue : 4  |  Page : 566-568
 

An institutional analysis of clinicopathological features of triple negative breast cancer


Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication21-Apr-2017

Correspondence Address:
D Sharma
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_534_16

Rights and Permissions

 » Abstract 

AIM: Most common breast cancer in India among female is breast cancer. This is heterogeneous disease, one of the subtypes, triple negative breast cancer (TNBC) defined as no expression of estrogen, progesterone receptor and neither expression nor amplification of human epidermal growth factor receptor 2/neu. TNBC is more frequent and aggressive in younger age group. The aim of this study was to evaluate clinicopathological features and outcome in TNBC versus non-TNBC group of patients. MATERIALS AND METHODS: Medical record of 373 patients diagnosed with invasive breast cancer from January 2011 to December 2014 was retrieved. The last follow-up was done in December 2015. Patients were evaluated and grouped on the basis of receptor status (TNBC vs. non-TNBC). Baseline categorical variables were analyzed using the Chi-square test or Fisher's exact test. Noncategorical variables were analyzed using t-test. RESULTS: Out of 373 cases, 149 (39.94%) were diagnosed as TNBC. Patients with TNBC had a significantly lower median age (45 vs. 48 years). Data analysis revealed significant difference in number of metastasis in TNBC as compared to non-TNBC group (45.6% vs. 25.6%, P = 0.001). In the present study, mean disease-free survival was 14.73 versus 17.03 months (P = 0.22, not significant) and mean overall survival was 24.71 versus 27.38 months (P = 05, significant) in TNBC versus non-TNBC group, respectively. CONCLUSION: TNBC represented 39.94% which is higher than the range normally reported in literature. TNBC is associated with younger age, high-grade tumors, and a higher rate of distant metastasis.


Keywords: Metastasis, treatment outcome, triple negative, triple negative breast cancer


How to cite this article:
Sharma D, Singh G. An institutional analysis of clinicopathological features of triple negative breast cancer. Indian J Cancer 2016;53:566-8

How to cite this URL:
Sharma D, Singh G. An institutional analysis of clinicopathological features of triple negative breast cancer. Indian J Cancer [serial online] 2016 [cited 2018 Jul 21];53:566-8. Available from: http://www.indianjcancer.com/text.asp?2016/53/4/566/204776



 » Introduction Top


Breast cancer is the most common cancer in women in India and is the most common cause of cancer death.[1] Triple negative breast cancer (TNBC) was defined as negativity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2)/neu (immunohistochemistry [IHC] score 0 or 1 + or fluorescent in situ hybridization [FISH] nonamplified). TNBC occurs in about 10%–24% of all breast cancer, it is more common in Asian countries.[2] It is an aggressive disease of young age group associated with advanced stage and increased risk of metastasis with decrease survival after metastasis.[3],[4],[5]

The aim of this study was to analyze the clinicopathological features and outcome in TNBC versus non-TNBC group of patients treated in a tertiary center in North India between the years 2011 and 2014.


 » Materials and Methods Top


We analyzed medical record of 416 patients diagnosed with invasive breast cancer between January 2011 and December 2014 in our hospital. Forty-two patients were excluded as they did not turn up for any treatment. The study population consisted of 373 patients with invasive breast carcinoma, whose ER, PR, and HER2/neu information available. The last follow-up of all patients was done in December 2015. The patients were then grouped on the basis of hormone receptor status (TNBC vs. non-TNBC) and were compared regarding the clinical presentation and survival in two groups of population. TNBC was defined as negativity for ER, PR, and HER2/neu (IHC score 0 or 1 + or FISH nonamplified). Overall survival (OS) was defined as the period from diagnosis to death from any cause. Disease-free survival (DFS) was defined as the period from diagnosis to first locoregional or distant recurrence. Patients who did not experience any event/death or were lost to follow-up were censored for survival analysis. Baseline categorical variables were analyzed using the Chi-square test or Fisher's exact test. Noncategorical variables were analyzed using t-test. DFS and OS curves were calculated using the Kaplan–Meier method. Log-rank test was used to calculate OS and DFS. A P < 0.05 was considered statistically significant.


 » Results Top


Patients

A total of 373 patients were analyzed for the study, out of which 149 (39.94%) patients were TNBC. The median age for the entire cohort was 45 years (range, 23–90 years) [Table 1]. The median age of the TNBC group was 45 years as compared to 48 years in non-TNBC group (P = 0.321). Tumor stage and nodal stage distribution in the two groups were not statically significant in two groups. Grade of the tumor was available for 286 patients; 30.4% had high-grade tumors. Patients with TNBC had a significantly higher proportion of high-grade tumors as compared to the non-TNBC group (28.18% vs. 20%, P = 0.04). Lympovascular invasion was also more in TNBC group as compared to non-TNBC group (45.7% vs. 41.8%; P = 0.174) although nonsignificant. 45.6% patients developed metastasis/locoregional recurrence in TNBC group during follow-up versus 28.6% patients in non-TNBC group (P = 0.001, significant). Within a median follow-up period of 26.5 months (2–63 months), 164 patients were clinically normal with no evidence of disease (54 in TNBC group vs. 110 in non-TNBC group, P = 0.004) tumor relapse occurred in 132 cases, among which 84 cases died, 43 (28.85%) patients in TNBC group as compared to 41 (18.30%) patients in non-TNBC group (P < 0.5). Mean DFS was 14.73 versus 17.03 months (P = 0.22, not significant) and mean OS was 27.38 versus 24.71 months (P = 0.05, significant) in TNBC versus non-TNBC group, respectively. The estimated 3 years OS is 43% versus 54% (TNBC vs. non-TNBC group), respectively (P = 0.134) [Figure 1].
Table 1: Characteristics of 373 breast cancer patients: Comparison between two groups

Click here to view
Figure 1: Kaplan–Meier for overall survival

Click here to view



 » Discussion Top


Breast cancer is a heterogeneous disease. As per American Society of Clinical Oncology guideline in TNBC, there is no expression of ER-negative, PR-negative, and there is neither amplification nor expression of HER2-negative in a tumor.[6] The overall rate of TNBC in our study is 39.94% which is comparable to results obtained by Nabi et al. in which 34.4% patients were TNBC.[7] TNBC is usually considered as a disease of younger age and presents at a higher stage and larger size when compared to the non-TNBC group and so in the present study although not significant.

In addition, TNBC has more than 20% greater incidence of visceral metastasis compared to the other breast cancer subtypes, which commonly metastasize to bone.[5],[8] TNBC is very aggressive tumor. It is more common in young age. In the present study, the mean age in TNBC group was 45 years as compared to 48 years in non-TNBC group. Different Indian and Western literature have also shown that TNBC is more frequent in young age.[2],[7],[9] The aggressive nature of TNBC can also be demonstrated as in the entire cohort, the number of patients with T3/T4 status was 69.1% versus 64.2% in two groups and also nodal positivity was higher in TNBC group (69% vs. 67%). This is in consistent to other Western literature where TNBC is associated with advanced stage.[5],[7],[8] Studies have shown that there is increased pathologic complete response (pCR) in TNBC patients who are treated with anthracycline and taxane-based neoadjuvant chemotherapy (NACT).[8] In study by Pogoda et al., there was pCR of 15% and only two-third of the patients received anthracycline-taxane NACT.[5] In this present study also, pCR was achieved in 13.22% versus 11.4% in the two groups although nonsignificant.

TNBC have been associated with increased risk of visceral metastasis as compared to bone metastasis.[3],[5],[7],[8] Present study has shown similar finding as total number of brain metastasis in TNBC was 24 as compared to 12 in non-TNBC group. (P = 0.001) Similarly, the metastasis to lung in the two group was 25 versus 21 (P = 0.037).

It has been seen that the survival in TNBC group is also inferior as compared to non-TNBC group.[8],[9],[10] In the present study, mean DFS was 14.73 versus 17.03 months (P = 0.22, not significant) and mean OS was 24.71 versus 27.38 months (P = 0.05, significant) in TNBC versus non-TNBC group, respectively.

This study also has limitation as it is a retrospective study with small sample size. Furthermore, the median follow-up is also very less. The cohort presented in tertiary center is not the representative of the general population as a whole. Furthermore, patients came from distant places being a tertiary center; therefore, percentage of loss to follow-up is high. A larger sample size with a long follow-up may reveal the significant differences between two groups.


 » Conclusion Top


TNBC is an aggressive disease mainly involving younger age group with higher stage. TNBC has propensity for visceral metastasis as compared to bone metastasis. Furthermore, they show a good response to NACT and taxane-based chemotherapy. More number of prospective randomized controlled trials are required to find out more effective therapy in TNBC patients to increase OS and DFS.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 » References Top

1.
Ferlay J, Soerjomataram I, Ervik M. GLOBACON 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No. 11. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://www.globacon.iarc.fr. [Last accessed on 2013 Dec 23].  Back to cited text no. 1
    
2.
Krishnamurthy S, Poornima R, Challa VR, Goud YG. Triple negative breast cancer – Our experience and review. Indian J Surg Oncol 2012;3:12-6.  Back to cited text no. 2
    
3.
Fulford LG, Reis-Filho JS, Ryder K, Jones C, Gillett CE, Hanby A, et al. Basal-like grade III invasive ductal carcinoma of the breast: Patterns of metastasis and long-term survival. Breast Cancer Res 2007;9:R4.  Back to cited text no. 3
    
4.
Bauer KR, Brown M, Cress RD, Parise CA, Caggiano V. 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 2007;109:1721-8.  Back to cited text no. 4
    
5.
Pogoda K, Niwinska A, Murawska M, Pienkowski T. Analysis of pattern, time and risk factors influencing recurrence in triple-negative breast cancer patients. Med Oncol 2013;30:388.  Back to cited text no. 5
    
6.
Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, et al. American Society of Clinical Oncology/College of American Pathologist guideline recommendation for immunohistochemical testing of estrogen and progesterone receptors in breast cancer. J Clin Oncol 2010;28:2784-95.  Back to cited text no. 6
    
7.
Nabi MG, Ahangar A, Wahid MA, Kuchay S. Clinicopathological comparison of triple negative breast cancers with non-triple negative breast cancers in a hospital in North India. Niger J Clin Pract 2015;18:381-6.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Liedtke C, Mazouni C, Hess KR, André F, Tordai A, Mejia JA, et al. Response to neoadjuvant therapy and long-term survival in patients with triple-negative breast cancer. J Clin Oncol 2008;26:1275-81.  Back to cited text no. 8
    
9.
Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, et al. Triple-negative breast cancer: Clinical features and patterns of recurrence. Clin Cancer Res 2007;13:4429-34.  Back to cited text no. 9
    
10.
Gogia A, Raina V, Deo SV, Shukla NK, Mohanti BK. Triple-negative breast cancer: An institutional analysis. Indian J Cancer 2014;51:163-6.  Back to cited text no. 10
[PUBMED]  [Full text]  


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  © 2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow