Abstract
Purpose: Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer with poor prognosis despite the high rates of response to chemotherapy. We aim to study the clinical features, factors influencing recurrence and survival outcomes of TNBC patients. Methods: We retrospectively studied the charts of patients with biopsy proven TNBC treated at The Clinical Oncology Department Ain-Shams University between 2009 and 2012. Results: One hundred and forty five patients fulfilled the eligibility criteria. The incidence of TNBC was 10.5% - 15% with a mean of 12% of all breast cancer patients. The follow-up duration ranged from six months to four years. The age range was 26 to 78 years. Infiltrating ductal carcinoma represented 93.1% of the pathologic types. 87% of patients were free of metastases (M0) at presentation. Clinical stages II and III represented 38 and 39.5% of the patients. 66% of patients had modified radical mastectomy. Following surgery, 77.5% of patients received adjuvant chemotherapy while 61% of the patients had adjuvant radiation therapy. Anthracyclines based chemotherapy was given to 52% of patients. Disease-free survival (DFS) of the M0 patients at 20 and 30 months was 92% and 80% respectively. Relapse occurred in 23% of M0 patients. After a mean duration of DFS of 15.1 months, the most common sites of metastases for relapsed M0 patients were pulmonary (44.8%), bone (41.4%), and locoregional (13.8%). The median overall survival (ORS) of patients was 18 months (1 - 45 months), whereas for the M1 group of patients the median ORS was 9 months (2 - 29 months). Conclusion: The incidence, pathological characteristics, and clinical behavior of TNBC were similar to what is mentioned in the literature. Adding taxanes to the chemotherapy protocols and using postoperative radiotherapy were both associated with a significant increase in the mean period of DFS, while did not significantly affect the ORS.
Highlights
Breast Cancer is still the most common malignancy in women worldwide, including Egypt (Cancer registry in Egypt)
TNBC (Triple negative breast cancer) is frequently identified by conventional immunehistochemical techniques, as these tumors lack staining for the estrogen receptor (ER), progesterone receptor (PR), and the human epidermal growth factor (HER2).[1]
We studied 145 out of the 154 patients diagnosed with TNBC who presented to our department over four years period where 9 patients had incomplete data in their charts (Table 1)
Summary
Breast Cancer is still the most common malignancy in women worldwide, including Egypt (Cancer registry in Egypt). A Claudin- low subtype is another described molecular subtype referring to tumors showing features of mesenchymal and mammary stem cells.[2] The criteria to identify subtypes were further recently refined at the 2013 conference, in that moderate or a strong expression of PR and Ki - 67 level were both recognized as being important to the surrogate definition of a “Luminal A-like” disease. According to these criteria, the subtypes in question have been defined as: Luminal A – ER positive, HER2 negative, Ki - 67 low, and PR high; Luminal B (HER2 negative) – ER positive, HER2 negative, and either Ki - 67 high or PR low; Luminal B-like (HER2 positive) – ER positive, HER2 over expressed or amplified, any Ki - 67, and any PR; HER2
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