Triple-Negative Breast Cancer in Brazilian Women without Metastasis to Axillary Lymph Nodes: Ten-Year Survival and Prognostic Factors.
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Date
2013-10
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Abstract
Aims: To determine the 10-year overall survival (OS) in triple-negative (TN) and non-TN
breast cancer (BC) patients, and to identify associated independent prognostic factors.
Study Design: Descriptive and survival.
Place and Duration of Study: Pathology Division at National Cancer Institute, Rio de
Janeiro, Brazil, between 1992-1996.
Methodology: Population: 348 women patients with invasive ductal carcinoma without
lymph node metastasis. Analyzed variables: age, treatment, surgery type, tumor size,
skin involvement, histological grade, vascular invasion, estrogen and progesterone
receptors, HER-2, Ki-67 and p53. Statistical analysis performed: Kaplan-Meier survival
curves, log rank test, and multivariate Cox models.
Results: 27% of the studied women were categorized as TNBC and 73%, as non-TNBC.
The former showed higher frequency of age <50yr, preoperative chemotherapy, tumors >5cm, high grade, vascular invasion, and positive p53, (P=.05). Ten-year OS among
TNBC patients was 61.6%, and 70.1% for non-TNBC patients (P=.058). Survival was
higher in TNBC patients treated with partial surgeries, tumors 5cm, without skin
involvement, low grade, and Ki-67 negative (P=.05). Among non-TNBC patients, higher
survival was observed in patients without skin involvement, low grade, no vascular
invasion, and p53 negative, (P=.05). Cox modelization showed a 2-fold higher death risk
for TNBC patients aged ≥50yr, about 2.5-fold higher risk related to preoperative
chemotherapy, high grade tumor and skin involvement, and a 3.0-fold higher risk for Ki-
67 positive patients (P=.05). For non-TNBC patients, a 2.0-fold increased death risk was
verified in patients with skin involvement and vascular invasion (P=.05).
Conclusion: TNBC patients showed a worse prognosis and survival when compared to
non-TNBC patients. A worse 10-yr survival among TNBC patients was associated with
age ≥50yr, preoperative chemotherapy, skin involvement, high histological grade, and Ki-
67 positive tumors. For non-TNBC patients, the worst prognosis was related to skin
involvement and vascular invasion. These predictors need to be further validating by
other studies.
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Keywords
Breast cancer, triple-negative breast cancer, survival, prognostic factors
Citation
Eisenberg Ana Lucia Amaral, Pinto Isabella Vitral, Koifman Sergio. Triple-Negative Breast Cancer in Brazilian Women without Metastasis to Axillary Lymph Nodes: Ten-Year Survival and Prognostic Factors. British Journal of Medicine and Medical Research. 2013 Oct-Dec; 3(4): 880-896.