Clinical Outcomes of Stage I to III Triple-Negative Breast Carcinoma in Young Women

Abstract

Purpose Triple-negative breast cancer (TNBC) is a genomically unique disease with aggressive clinical behavior. Breast cancer in young women has grave socioeconomic impact with both treatment and survivorship issues affecting fertility, family life, and careers. A study of the clinical outcomes of patients with TNBC in this subgroup is needed to understand these sociocultural and economic effects. Methods Data from patients age 40 years or younger with biopsy-proven nonmetastatic TNBC who were treated between January 1, 2011, and March 31, 2014, at our institute were procured using a structured proforma. Survival estimates and additional association analyses were performed using the Kaplan–Meier method, χ2 test, Fisher’s exact tests, and Cox proportional hazards regression model. Results One hundred sixty patients were analyzed, with a median follow-up of 54 months (range 4 to 88 months). The majority of patients had early (T2; 46.9%) tumors that were mostly either node negative (40.6%) or N1 (35.6%), with composite stage II (50.7%) disease. Only one third of patients (35%) received neoadjuvant chemotherapy, and the rest were treated with adjuvant chemotherapy. Three fourths of patients (75%) received both anthracyclines and taxanes. After neoadjuvant chemotherapy, one fourth (24.5%) achieved a pathologic complete response, a predictor of good prognosis. The majority of patients (71.2%) underwent modified radical mastectomy, which resulted in a low rate of breast conservation surgery (28.8%). Among those with an indication for radiotherapy, most (80%) received the same. Among all patients, 47 (29.3%) experienced relapse, with a median time of 17.5 months (range, 6 to 84 months) to relapse. Most patients experienced relapse at distant sites (76.5%), with fewer local (10.6%) and regional (6%) relapses. The brain was the single most common site of distant metastasis (38.3%). Bone alone metastases comprised 12.8% of relapses. The 4-year overall survival was 75.2% (SE = 3.5) and the 4-year disease-free survival was 68.3% (SE = 3.7). Additional analyses demonstrated that higher composite stage was associated with significantly lower survival and that attaining a pathologic complete response to neoadjuvant chemotherapy was associated with a statistically significant survival advantage. Conclusion TNBC in young women has poorer survival outcomes compared with other subgroups. Neoadjuvant chemotherapy with the aims of achieving a complete pathologic response should be considered even for early-stage disease. These results justify intensive efforts for socioeconomic support for these women, especially in a developing nation, and focused research into more therapeutic options. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.