Triple negative breast cancer: A clinico-epidemiological and histopronostic study of 90 cases
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Abstract
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.
Keywords:
Breast cancer, Triple negative, Immunohischemistry, Treatment##plugins.themes.academic_pro.article.details##
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.