Abstract
BackgroundBecause there is no exact therapeutic target, the systemic treatment of triple-negative breast cancer (TNBC) still relies on chemotherapy. In terms of local treatment, based on the highly malignant characteristics of TNBC, it is still uncertain whether patients should be given more aggressive local treatment.MethodsThis study was based on the SEER database. 13,262 TNBC patients undergoing chemotherapy were included. According to local treatment methods, patients were divided into breast-conserving surgery with radiotherapy (BCS + RT), total mastectomy alone and total mastectomy with radiotherapy (Mastectomy+RT). Kaplan-Meier survival analysis drew the survival curves of Overall Survival (OS) and Breast Cancer Specific Survival (BCSS), and Cox proportional risk regression models were used to analyze the impact of different local treatments on OS and BCSS.ResultsAfter adjusting confounding factors, Mastectomy alone group (HR = 1.57; 95%CI: 1.40–1.77) and Mastectomy+RT group (HR = 1.28; 95%CI: 1.12–1.46) were worse in OS than BCS + RT group, and Mastectomy+RT group (HR = 0.81; 95%CI: 0.73–0.91) was better in OS than Mastectomy alone group. The effect of local treatment for BCSS was similar to that of OS. After stratification according to age, tumor size and lymph node status, when the age was less than 55 years old, at T4, N2 or N3 category, there was no statistical significance between the BCS + RT group and the Mastectomy+RT group in OS or BCSS (all P > 0.05). When the age was less than 65 years old, at T1, T2 or N0 category, there was no statistical significance between the Mastectomy alone group and the Mastectomy+RT group in OS or BCSS (all P > 0.05). The results of other stratified analyses were basically consistent with the results of total population analysis.ConclusionThe survival benefit of breast-conserving surgery with radiotherapy was higher than or similar to that of total mastectomy TNBC patients.
Highlights
Because there is no exact therapeutic target, the systemic treatment of triple-negative breast cancer (TNBC) still relies on chemotherapy
They were divided into three groups according to local treatment methods: 6116(46.12%) patients in the breastconserving surgery with postoperative radiotherapy (BCS + RT) group, 4483(33.80%) patients in the total mastectomy alone group, and 2663(20.08%) patients in the total mastectomy with postoperative radiotherapy (Mastectomy+RT) group
After stratification according to age, tumor size and lymph node status, when the age was less than 55 years old, at T4, N2 or N3 category, there was no statistical significance between the Breast-conserving Surgery (BCS) + RT group and the Mastectomy+RT group in Overall Survival (OS) or Breast Cancer Specific Survival (BCSS)
Summary
Because there is no exact therapeutic target, the systemic treatment of triple-negative breast cancer (TNBC) still relies on chemotherapy. Lehmann et al [4] proposes four types based on differences in gene expression profiles of TNBC patients, including basal-like type 1, basal-like type 2, interstitial type and androgen receptor type, and each type showed significant differences in initial symptoms and recurrence patterns. Due to the lack of expression of ER, PR and HER-2, endocrine therapy and anti-HER-2 targeted therapy for TNBC patients are ineffective, so currently chemotherapy is still the main method of systemic treatment [9]. TNBC is sensitive to chemotherapy at the initial stage, the risk of recurrence within 3–5 years after adjuvant treatment is higher than that of other subtypes, so combined local treatment is essential to reduce tumor burden [5]
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