Triple negative breast cancer: A clinico-epidemiological and histopronostic study of 90 cases
Keywords:
Breast cancer, Triple negative, Immunohischemistry, TreatmentAbstract
Purpose: The aim of this study was to describe the clinico-epidemiological and histopronostic characteristics of triple negative breast cancer (TNBC) and to evaluate the therapeutic results in tunisian women.
Methods: We reported the results of a retrospective study including 90 patients treated for TNBC between Junuary 2008 and December 2009 in the Salah Azaiz Institute of Tunis.
Results: TNBCoccured in 14% of diagnosed breast cancers. The mean age at diagnosis was 53.67 years. Family history of breast cancer was reported in 10% of cases.The majority of tumors were classified as T2 (41%) and associated with invasive ductal carcinoma histological type (99%) and SBR grade-II (54%). Tumor lymph node metastases were detected in 44% of patients.Among operated patients, 46% of patients underwent conservative surgery and 54% radical surgery. Chemotherapy and postoperative radiotherapy were given in97% and 80%of patients, respectively. After a median follow-up of 33.51 months, 61% of patients remained free of disease, 12% hadloco-regional recurrence, 9% had disease progression during chemotherapy and 21% developed systemic disease.
Conclusion: TNBC diagnosis is often made in the advanced stage and has a tendency to recur after treatment. The variable responseto chemotherapy is due to the molecular tumor heterogeneity. The development of targeted therapies is necessary to improve outcome of chemoresistant TNBC.
Downloads
References
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-colled triple-negative phenotype: a population-based study from the California cancer registry. Cancer 2007;109:1721-28.
Perou C M. Molecular stratification of triple-negative breast cancers. The Oncologist 2011;16:61-70.
Bertucci F, Finetti P, Cervera N, Esterni B, Hermitte F, Viens P, et al. How basal are triple-negative breast cancers? Int J Cancer 2008;123:236-40.
Bidard FC, Conforti R, Boulet T, Michiels S, Delaloge S, André F. Does triple-negative phenotype accurately identify basal-like tumor? An immunohistochemical analysis based on 143 triple negative breast cancers. Ann Oncol 2007;18:1285-6.
Rakha E, Reis-Filho JS. Basal-like breast carcinoma, from expression profiling to routine practice. Arch Pathol Lab Med 2009;133:860-7.
Cheang MD, Voduc D, Bajdik C, Leung S, McKinney S, Chia SK, et al. Basal-like breast cancer defined by five biomarkers has superior prognostic value than triple-negative phenotype. Clin Cancer Res 2008;14:1368-76
Farmer P, Bonnefoi H, Becette V, Tubiana-Hulin M, Fumoleau P, Larsimont D, et al. Identification of molecular apocrine breast tumours by microarray analysis. Oncogene 2005;24:4660-71.
Prat A, Parker J, Karginova O, Fan C, Livasy C, Herschkowitz JI, et al. Phenotypic and molecular characterization of the claudin-low intrinsic subtype of breast cancer. Breast Cancer Res2010;12:R68.
Carey LA, Perou CM, Livasy CA, Dressler LG, Cowan D, Conway K, et al. Race, breast cancer subtypes, and survival in the Carolina breast cancer study. JAMA 2006;295:2492-502
Rakha EA, El-Rehim DA, Paish C, Green AR, Lee AH, Robertson JF, et al. Basal phenotype identifies a poor prognostic subgroup of breast cancer of clinical importance. Eur J Cancer 2006;42:3149-56.
Vona-Davis L, Rose DP, Hazard H, Howard-McNatt M, Adkins F, Partin J, et al. Triple-negative breast cancer and obesity in a rural Appalachian population. Cancer Epidemiol Biomarkers Prev 2008;17:3319-24.
Dent R, Trudeau M, Pritchard KL, 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.
Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, et al. Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J ClinOncol 2006;24:5652-7.
Amirikia KC, Paul M, Jason B, Newman LA. Higher population-based incidence rates of triple-negative breast cancer among young African-american woman. Cancer 2011;117:2747-53.
Ihemelandu CU, Leffall LD Jr, Dewitty RL, Naab TJ, Mezghebe HM, Makambi KH, et al. Molecular breast cancer subtypes in premenopausal and postmenopausal African-American women: age-specific prevalence and survival. J Surg Res. 2007 Nov;143:109-18.
Bown RL, Duffy SW, Ryan DA, Hart IR, Jones JL. Early onset of breast cancer in a group of british black women. Br J Cancer 2008;98:277-81.
Trivers KF, Lund MJ, Porter PL, Liff JM, Flagg EW, Coates RJ, et al.The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control 2009;20:1071-82.
Pierobon M, Frankenfeld CL. Obesity as a risk factor for triple-negativebreast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat 2013 Jan;137:307-14.
Shinde SS, Forman MR, Kuerer HM, Yan K, Peintinger F, Hunt KK, et al. Higher parity and shorter breastfeeding duration: association with triple-negative phenotype of breast cancer. Cancer 2010;116:4933-43.
Dolle JM, Daling JR, White E, Brinton LA, Doody DR, Porter PL, et al. Risk factors for triple-negative breast cancer in women under age 45. Cancer Epidemiol Biomarkers Prev 2009;18:1157-66.
Phipps AI, Chlebowski RT, Prentice R, McTiernan A, Wactawski-Wende J, Kuller LH, et al. Reproductive history and oral contraceptive use in relation to risk of triple-negative breast cancer. J Natl Cancer Inst 2011;103:470-7.
Atchley DP, Albarracin CT, Lopez A, Valero V, Amos CI, Gonzalez-Angulo AM, et al. Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer. J ClinOncol 2008;26:4282-8.
Sook Ko ES, Lee BH, Kim HA, Noh WC, Kim MS, Lee SA. Triple-negative breast cancer: correlation between imaging and pathological findings. EurRadiol 2010;20:1111-7.
Kojima Y, Tsunoda H. Mammography and ultrasound features of triple-negative breast cancer. Breast Cancer 2011;18:146-51.
Boisserie-Lacroix M, Mac Grogan G, Debled M, Ferron S, Asad-Syed M, Brouste V, et al. Radiological features of triple-negative breast cancers (73 cases). DiagnInterv Imaging2012;93:183-90.
Yang WT, Dryden M, Broglio K, Gilcrease M, Dawood S, Dempsey PJ, et al. Mammographic features of triple receptor-negative primary breast cancers in young premenopausal women. Breast cancer Res Treat 2008;111:405-10.
Rakha EA, El-Sayed ME, Green AR, Lee AH, Robertson JF, Ellis IO.Prognostic markers in triple-negative breast cancer. Cancer 2007;109:25-32.
Dawson SJ, Provenzano E, Caldas C. Triple negative breast cancers: clinical and prognostic implications. Eur J Cancer 2009;45:27-40.
Foulkes WD, Metcalfe K, Hanna W, Lynch HT, Ghadirian P, Tung N,et al. Disruption of the expected positive correlation between breast tumor size and lymph node status in BRCA-1 related breast carcinoma. Cancer 2003;98:1569-77.
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 ClinOncol 2008;26:1275-81.
Carey LA, Dees EC, Sawyer L, Gatti L, Moore DT, Collichio F,et al. The triple negative paradox: primary tumor chemosensitivity of breast cancer subtypes. Clin Cancer Res 2007;13:2329-34.
Metzger-Filho O, Tutt A, de Azambuja E, Saini KS, Viale G, Loi S, et al. Dissecting the hetero¬geneity of triple-negative breast cancer.J ClinOncol 2012;30:1879-87.
Haffty BG, Yang Q, Reiss M, Kearney T, Higgins SA, Weidhaas J, et al.Locoregional relapse and distant metastasis in conservatively managed triple negative early-stage breast cancer. J ClinOncol 2006;24:5652-7.
Lin NU, Claus E, Sohl J, Razzak AR, Arnaout A, Winer EP. Sites of distant recurrence and clinical outcomes in patients with metastatic triple-negative breast cancer. Cancer 2008;113:2638-45.
Kennecke H, Yerushalmi R, Woods R, Cheang MC, Voduc D, Speers CH, et al. Metastatic behavior of breast cancer subtypes. J ClinOncol2010;28:3271-7.
