|Year : 2016 | Volume
| Issue : 4 | Page : 566-568
An institutional analysis of clinicopathological features of triple negative breast cancer
D Sharma, G Singh
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi, India
|Date of Web Publication||21-Apr-2017|
Department of Radiotherapy, VMMC and Safdarjung Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
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
| » Introduction|| |
Breast cancer is the most common cancer in women in India and is the most common cause of cancer death. 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. It is an aggressive disease of young age group associated with advanced stage and increased risk of metastasis with decrease survival after metastasis.,,
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|| |
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|| |
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|
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| » Discussion|| |
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. 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. 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., 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.,, 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.,, 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). In study by Pogoda et al., there was pCR of 15% and only two-third of the patients received anthracycline-taxane NACT. 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.,,, 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.,, 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|| |
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.
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Conflicts of interest
There are no conflicts of interest.
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